Intactivism News

July - September 2009

Circumcision (Infant Male)
RESOURCE MANUAL

Until recently, only public health and religious views were taken into consideration in the debate over infant male circumcision. However, our understanding of medical practice must change as research findings become available. The College is issuing this guide for physicians regarding routine infant male circumcision in light of evidence?based medicine and contemporary principles in ethics, law and human rights.

Infant male circumcision was once considered a preventive health measure and was therefore adopted extensively in Western counties. Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention. From a religious standpoint, infant male circumcision is acknowledged to be an important ritual and an integral part of Jewish and Islamic religions. Male circumcision is also practiced in other parts of the world as a rite of puberty.

A wider societal discussion on infant male circumcision is warranted based on a current understanding of bioethics that takes ito account the non-therapeutic nature of the procedure as well as the high importance it plays in religious and traditional customs. This paper provides a discussion on current medical perspectives as well as relevant legal, human rights, and ethical considerations.
...

... routine removal of normal tissue in a healthy infant, is not recommended.

... proxy consent by parents is now being questioned. Many believe it should be limited to consent for diagnosis and treatment of medical conditions, and that it is not relevant for non-therapeutic procedures.

... an infant has rights that include security of person, life, freedom and bodily integrity....

Advise parents that the current medical consensus is that routine infant male circumcision is not a recommended procedure; it is non-therapeutic and has no medical prophylactic basis; it is a cosmetic surgical procedure; current evidence indicates that previously-thought prophylactic public health benefits do not outweigh the potential risks.

Provide objective medical information about the risk of complications and potential harm in infant male circumcision.

Discuss the new ethical considerations of infant's rights and proxy consent in a non-therapeutic procedure.

How does this differ from any other infant circumcision performed by a non-doctor?

Man guilty in child circumcision case

By Steve Obnesorge

MORGANTON, NC (WBTV) - A jury has found a father guilty on one count of
abusing his son by performing a circumcision when the child was an
infant. The jury announced the verdict Thursday afternoon, but jurors
are deadlocked on the other count involving a second child.

The case is being heard in the Caldwell County court. On Wednesday, the
defendant, John Marlowe, represented himself and admitted he circumcised
two of his children without any anesthetic. He says God told him to
perform the circumcisions.

"The main reason I did it was, the Holy Spirit pressed me to do it," he
said.

Marlowe said he learned how to do it from reading books and the
internet. He used his shirt to demonstrate to the courtroom his
surgical method.

"[I] pulled the skin over the tip and cut it off," he said.

He also revealed that he has circumcised three children: one in
Mecklenburg County and two in Caldwell County. At this time, he has not
been charged in connection with the alleged incident in Mecklenburg
County.

Jurors must decide what extent the children suffered and if there was any
abuse.

Marlowe says the pain couldn't have been that bad for the infants. He
says he knows because he performed a circumcision on himself a few years
ago when he was 30.

"The pain did not overwhelm me or stop me," he said. "Within an hour or
so, [I] was able to put in 13 stitches."

He claims he did the right thing with his children and that putting him
in jail for it sets a bad precedent.

[No, an excellent precedent.]

Late Wednesday afternoon, the jury told the judge they had reached a
verdict in the case involving one child, but the jury had not reached a
decision in the other child's case. The judge sent the jury home
Wednesday night and they will come back Thursday to continue deliberating
in the second case.
...

Body of teenager found in hut

The body of an 18-year-old would-be initiate was found in a hut in the village of Nyandeni, in the Libode area of Transkei, on Tuesday morning, the Eastern Cape health department said.

Spokesperson Sizwe Kupelo said the corpse was discovered by community members.

It appeared that an illegal initiation school had been run at the hut, and that two other youths circumcised along with the 18-year-old had fled.

The "traditional nurse" caring for the youths was reportedly a schoolmate.

Police were called to the scene, and an autopsy would be considered. The cause of death was not yet known.

Kupelo said the death brought the number of circumcision-related fatalities in the province to 56 since the start of the winter circumcision season in June.

If other non-doctors can, why can't he? (Some seriously argue this.)

September 29, 2009

Accused Polygamist Defends Circumcision Of Sons

CALDWELL COUNTY, N.C. -- A man accused of child abuse for circumcising his own sons defended himself in court on Tuesday, saying the case is not about the children at all.

“This is not about circumcision. It’s about religious freedom,” said Johnny Marlowe in a Caldwell County courtroom.

Marlowe is representing himself. He asked the jury to keep an open mind when they consider his actions.

Marlowe does not deny that he used a box cutter to circumcise two of his newborn sons in 2005. Prosecutors said that in one of the cases, he strapped his son down and used a hot light bulb to stop the bleeding.

The defendant was convicted in May on charges he abused the two women he referred to as his wives. He broke down in tears in front of the jury as he described his time in jail awaiting that trial, saying his religious beliefs were not respected.
...

Infant pain alters adult reactions

Infant Pain, Adult Repercussions: How Infant Pain Changes Sensitivity In
Adults ScienceDaily (Sep. 28, 2009)
— Scientists at Georgia State University have uncovered the mechanisms of how pain in infancy alters how the brain processes pain in adulthood.

Research is now indicating that infants who spent time in the neonatal
intensive care unit (NICU) show altered pain sensitivity in adolescence.
These results have profound implications and highlight the need for
pre-emptive and post-operative pain medicine for newborn infants.

[And for avoiding unnecessary painful procedures.]

...

Endogenous opioid peptides, such as beta-endorphin and enkephalin,
function to inhibit pain. They're also the 'feel good' substances that are
released following high levels of exercise or love. Since these peptides
are released following injury and act like morphine to dampen the
experience of pain, LaPrairie and Murphy tested to see if the rats, who
were injured at birth, had unusually high levels of endogenous opioids in
adulthood.

To test this hypothesis, LaPrairie and Murphy gave adult animals that were
injured at the time of birth a drug called naloxone. This drug blocks the
actions of endogenous opioids. After animals received an injection of
naloxone, they behaved just like an uninjured animal.

... Using a variety of anatomical techniques, the
investigators showed that animals that were injured at birth had
endogenous opioid levels that were two times higher than normal.

...

Interestingly, while there is an increase in endorphin and enkephalin
proteins in adults, there is also a big decrease in the availability of mu
and delta opioid receptors. These receptors are necessary in order for
pain medications, such as morphine, to work. This means that it takes more
pain-relieving medications in order to provide relief as there are fewer
available receptors in the brain. Studies in humans are reporting the same
phenomenon.

The number of invasive procedures an infant experienced in the NICU is
negatively correlated with how responsive the child is to morphine later
in life; the more painful procedures an infant experienced, the less
effective morphine is in alleviating pain.

The study by LaPrairie and Murphy has major implications for the treatment
of infants in neonatal intensive care. On average, a prematurely born
infant in a neonatal intensive care unit will experience 14 to 21 invasive
procedures a day, including heel lance, insertion of intravenous lines,
and intubation. All of these procedures are quite painful and are
routinely conducted without prior analgesics or anesthetics.

"It's imperative that pain be treated," Murphy said. [...or prevented.] "We once assumed that a newborn infant is
insensitive to pain, and this is clearly not the case. Even at that period
of time, the central nervous system is able to respond to pain, and our
studies show that the experience of pain completely changes the wiring of
the brain in adulthood."

DIY circumcisions go wrong

Port Elizabeth - Two 13-year-old boys had to receive medical treatment after botching their do-it-yourself circumcisions last week, the Eastern Cape health department said on Monday.

Spokesperson Sizwe Kupelo said the boys, from Marhubeni village near Libode, circumcised each other.

However they removed not only the foreskins, but also the glans of their penises.

Kupelo said they were admitted to Libode's St Barnabas hospital, treated and discharged.

September 26, 2009

Circumcision not enough to stop HIV, experts warn experts

By ARTHUR OKWEMBA

As thousands of young men in Nyanza Province troop to health centres to be
circumcised in hopes of fending off HIV, new studies show it might be too
early to claim victory. Although circumcision has been touted as one of
the ways to prevent HIV infection, recent findings show an increase in HIV
infection in regions where most males are circumcised.

According to findings of the Kenya Aids Indicator Survey (Kais)
released last week, North Eastern and Coast provinces, where 97 per
cent of males are circumcised, registered an increase in HIV prevalence.

Within a span of five years, HIV prevalence in North Eastern and Coast
provinces increased from 0 to 1.0 per cent and from 5.8 per cent to 8.3 per cent respectively.
[If you wanted to express those figures in the inflammatory way they do when it promotes circumcision, you could say the HIV rate increased by 40% in Coast province, and - assuming "0%" means a figure of up to 0.05% has been rounded down - more than 1900% in North Eastern province.]
In the same period, HIV prevalence in Nyanza
Province, where about 48 per cent of males are circumcised, stood at 15
per cent, the highest in the country. [But those raw figures only establish a correlation between "living in an area where more men are circumcised" and "having a low HIV rate" not a correlation between "being circumcised" and "not having HIV".]

These are sobering statistics for young men who have rushed to get
circumcised in he belief that doing so would provide complete
protection from HIV infection. The new findings of growing HIV
prevalence among circumcised males indicates the practice cannot
completely protect an individual from HIV infection unless it is
combined with other practices including using condoms, being faithful to
one partner, or abstaining from sex.

A traveller came to a farmhouse and offered to make the occupants Nail Soup in return for a night's shelter. He threw a large nail in a pot of boiling water. Then he said -
"A nail cannot completely make Nail Soup unless it is combined with other soup ingredients including using salt and pepper, herbs, onions, carrots, leeks, potatoes or meat."

In the morning he went on his way, refreshed after a night in a comfortable bed, minus the nail but with some gold coins in his pocket and the thanks of the family ringing in his ears for the wonderful nail that made such delicious Nail Soup.

Health officials acknowledge that getting people to look at
circumcision in the larger context of other factors and strategies can be
challenging. "The figures from these two provinces are sending a warning
that circumcision alone is not the magic bullet to controlling the
disease. Other methods have to be used in combination," said Dr Ibrahim
Mohammed, Head of National Aids and STD Control Programmes in the Ministry
of Medical Services.

The increase in prevalence in communities that circumcise indicates
there are other factors that contribute to the spread of the disease among
males in addition to being uncircumcised. Multiple sexual partners, low
condom use and alcohol and drug abuse are some of the factors.

"Unless we address all the reasons predisposing people to HIV
infection, we might not make much headway," said Judy Adero, who has lived
with the virus for nine years. But scientists still believe circumcision
will result in the lowering of HIV prevalence in provinces such as Nyanza.

Dr David DeCock, director of the Kenya office of the US Centers for
Disease Control, said there is no doubt that circumcision prevents HIV
infection. The Kais study shows HIV prevalence among circumcised men aged
between 20 and 64 years was approximately three to seven times lower than
among uncircumcised men in the same age range.

The study further shows that the rate of HIV prevalence among
circumcised men was 3.9 per cent compared to 13.2 per cent among the
uncircumcised men. Buoyed by these significant differences, the government
and other organisations have opened 200 circumcision centres.

More than 30,000 men have been circumcised since the call first went out;
the target of 100,000 circumcised men is expected to be reached by year's
end.

Meanwhile, female activists have criticised the way the whole operation is
being carried out, arguing that it is making women more vulnerable as men
engage in sex with multiple partners secure in the knowledge that they are
safe.

The decision to adopt circumcision as one method in the HIV prevention
strategy has been informed by research findings of three main studies done
in South Africa, Uganda and Kenya which showed circumcision to reduce the
risk of HIV infection by up to 60 per cent.

This was followed by World Health Organisation and UNAids issuing
strong recommendations for increased male circumcision rates in
countries where the HIV prevalence is high. Two years ago, Kim Dickson,
coordinator of the joint WHO/UNAids working group that came up with the
recommendations told the journal New Scientists: "We reviewed all the
evidence, and the evidence is compelling."

In the South Africa study, circumcision was found to reduce HIV
infection rates by more than 60 per cent in a group of 3,000
HIV-negative men. Of the 1,546 men who were circumcised, 20 became
infected with HIV while 49 of the 1,582 uncircumcised men became
infected.

The findings made the South African scientists undertake large-scale male
circumcision as a possible strategy for preventing two million HIV
infections and 300,000 deaths in their country over the next 10 years. In
December 2006, the Data Safety Monitoring Board that was overseeing the
Kenyan and Ugandan male circumcision trials announced the operation was a
safe and effective way to reduce HIV infection among men.

Researchers found that it reduced by nearly a third the risk of contracting HIV, the virus that leads to Aids.

It has been hailed as a significant, scientific breakthrough, but a global vaccine is still some way off.

The study was carried out by the US army and the Thai government over seven years on volunteers - all HIV-negative men and women aged between 18 and 30 - in parts of Thailand.

The vaccine was a combination of two older vaccines that on their own had not cut infection rates.

Half of the volunteers were given the vaccine, while the other half were given a placebo - and all were given counselling on HIV/Aids prevention.

[And presumably none of them knew which they had been given, unlike the circumcision trials.]

Participants were tested for HIV infection every six months for three years.

[One and a half times as long as the circumcision trials.]

The results found that the chances of catching HIV were 31.2% less for those who had taken the vaccine - with 74 people who did not get the vaccine infected and 51 of the vaccinated group infected.

[And since a vaccine will protect equally men from infection by women, women from men, men from men, children from mothers, and anyone from IV infection, whether medical, pseudo-medical ("needle men") or recreational drug use, that percentage stands for much more than the circumcision trials' "60%" protection of men from infection by women only.]

The vaccine is based on B and E strains of HIV that most commonly circulate in Thailand, not the C strain which predominates in Africa.

'Encouraging'"This result is tantalisingly encouraging. The numbers are small and the difference may have been due to chance, but this finding is the first positive news in the Aids vaccine field for a decade," said Dr Richard Horton, editor of the Lancet medical journal.

"We should be cautious, but hopeful. The discovery needs urgent replication and investigation."

Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases said: "For the first time, an investigational HIV vaccine has demonstrated some ability to prevent HIV infection among vaccinated individuals.

[The tone of cautious optimism and careful explanation of the actual figures is in stark contrast to the hysterical advocacy in stories about circumcision and HIV.]

, 2009

Intactivist Demonstration

AAP - October 17- 20, 2009 - Washington, DC

Each year a group of Intactivists demonstrates outside the American
Academy of Pediatrics conference holding signs, passing out literature,
and raising awareness about the importance of genital integrity. Most
pediatricians are friendly, and many good conversations have occurred.

This is the most crucial year ever - the AAP is on the verge of issuing a
statement in support of neonatal circumcision (for the first time ever).

We are trying to find individuals who will come and hold signs outside the
AAP during their conference. We will gladly supply you with signs.

If you can come or you want more information, please contact Dan
Strandjord at: danstrandjord@gmail.com
I hope you can make it. If you can't attend in person, PLEASE make sure
the chair of the AAP task force has heard from you:
Susan Blank, M.D.
New York City Department of Health and Mental Hygiene
125 Worth St.
New York, NY 10013
You can find additional key AAP and CDC contacts with e-mails at
http://www.circumcisionandhiv.com/the-aap-project.html

, 2009

To: restore-list@eskimo.com
14-Sept-2009
For Immediate Release
NORM-UK welcomes Professor Jack Cohen
A prominent reproductive biologist has thrown his weight behind NORM-UK,
the charity concerned with the male foreskin and campaigning for personal
choice in circumcision.
Professor Jack Cohen, who has an academic career spanning 55 years, has
co- authored books with Terry Pratchett and worked as a consultant on
science fiction productions, joins actor Alan Cumming and art critic Brian
Sewell as a patron of the charity.
Speaking as an honoured guest at the charity's annual general meeting in
Staffordshire, Professor Cohen said. "I'm delighted to join NORM-UK, to
help to raise public awareness of the very real issues around male
circumcision."
"As a tissue researcher in Boston in 1963-4 I became known as the prepuce
man, collecting 400 infant foreskins for experimentation in one year
(sometimes from parents who had fainted after watching the surgery on
their son). Now it seems this poacher has turned gamekeeper!"
"Although I circumcised my first two sons", he added, "I have increasingly
questioned the practice, and its origins. I support the principle that
every man and woman has the right to veto alterations of their body.
Unfortunately in its early historical form circumcision was designed to
weed out and ostracise those who resisted authority -denying them the
right to reproduce. Thus the harm has become deeply entrenched with
questioning seen as an aberration. I'm happy to see this is beginning to
change."
Asked whether the African circumcision experiments should sway parents who
are questioning circumcision, Professor Cohen said, "There are still no
good grounds for believing that circumcision will protect a boy from HIV
in the future. The small numbers who were apparently protected by surgery
in the trials don't justify the policy conclusions drawn, particularly
when they stand in contrast to population evidence, in Africa and
elsewhere."
Dr John Warren, Chairman of NORM-UK commented, "We are delighted to have
Professor Cohen as a supporter of our work, and we concur with his view of
the African HIV experiments. Parents who think circumcising might reduce
their child's risk of HIV should ask, why should Israel have the same HIV
rate as Sweden when one is almost entirely circumcised and one almost
entirely not circumcised? They should also ask whether they can be sure of
his future sexuality. There is no evidence that circumcision protects gay
men at all and in fact in Britain a circumcised gay man is 20% more likely
to report having been diagnosed HIV+ than a gay man who has not been
circumcised." --Ends--
--Notes for Editors-- * The Annual General Meeting of NORM-UK was held in
Stone, Staffordshire on Saturday September 12th. Other speakers included
Peter Bolton who has written a philosophy dissertation on the ethics of
infant male circumcision, and Dr Anthony Lempert of the Secular Medical
Forum. * A number of photographs from the event are available for use. *
Professor Cohen is pictured at the NORM-UK AGM with a banner for the
Genital Autonomy campaign, in which NORM-UK is a partner along with
FORWARD, the British organisation concerned with female genital cutting
--About Professor Jack Cohen-- Jack Cohen worked for Birmingham
University's Zoology Department for 30 years More recently at Warwick
University, he bridged the Ecosystems Unit of the Biology Dept and the
Mathematics Institute, and his brief included bringing more science to
more public awareness - one of his key interests. In the mid 90s he was
visiting professor at the Weizmann Institute, Israel.
Professor Cohen has published about 120 research papers. His books include
Living Embryos (Pergamon, 1963, 1967, 1980), a classic textbook that sold
more than 100,000 copies; Reproduction (Butterworth's); Spermatozoa,
Antibodies and Infertility (Blackwell); The Privileged Ape (Parthenon), a
rather different look at human evolution. Professor Cohen now works with
the mathematician Ian Stewart (Does God Play Dice? and the 1997-8 Royal
Institution Christmas Lectures) with whom he has explored issues of
complexity, chaos and simplicity. Their first joint book, The Collapse of
Chaos, was published by Viking/Penguin ('94, re-issued 2000), and their
Figments of Reality: the evolution of the curious mind (Cambridge
University Press) was published in '97. Both authors cooperated with Terry
Pratchett on popular Discworld titles.
--ABOUT NORM-UK-- * NORM-UK was founded in 1995 and gained charity status
in 1998. The charity aims to raise the awareness of the function and value
of the foreskin, the risks of circumcision and the non or less invasive
alternatives. * In 2008 with FORWARD, the British organisation concerned
with female genital cutting, and The Tasmanian Children's Commissioner
Paul Mason, NORM-UK launched the Genital Autonomy Campaign, arguing that
non-therapeutic genital surgery is a personal choice which can only be
made in adulthood. For more information see
http://www.genitalautonomy.org * NORM-UK
is presently funded entirely by personal donations, is run by one full
time member of staff and an army of determined volunteers. * The website
at http://www.norm-uk.org provides a wealth of
information and has been verified as compliant with the Health on the Net
(HON) code of medical ethics since 2003. * Since 1995 NORM-UK has received
over 5000 letters and emails from men unhappy about their circumcision. *
NORM-UK is a member of the Men's Health Forum (MHF), the Alliance for
Transforming the Lives of Children (ATLC), and the International Coalition
for Genital Integrity (ICGI). * NORM-UK has no formal connection or
affiliation with the US-based National Organisation of Restoring Men
(NORM) and this acronym is no longer used by NORM-UK.
--ABOUT CIRCUMCISION AND HIV-- An HIV rate of 0.1% is reported in Israel
and in Sweden. Factsheets on HIV by country can be found at:
http://www.unaids.org/en/KnowledgeCentre/HIVData/Epidemiology/epifact
sheets. asp A useful summary of HIV by country can be found at:
http://en.wikipedia.org/wiki/List_of_countries_by_HIV/AIDS_adult_prev
alence_ rate
The National Gay Men's Sex Survey in 2001 by Sigma Research found that HIV
rates were 6.1% among British gay men who were circumcised and 5% among
British gay men who were not circumcised. The report is found at:
http://www.sigmaresearch.org.uk/downloads/report02d.pdf

Parents sue over baby's death after circumcision

Josh Verges

The parents of a 6-week-old boy who bled to death after a circumcision at Rosebud’s Indian Health Service Hospital last year are suing the government for wrongful death.

According to documents filed Wednesday in federal court, Eric Keefe underwent a circumcision on June 13, 2008. His mother gave him Motrin and Tylenol for pain and he suffered massive blood loss at home that night, dying at the hospital the next morning.

His parents, Forrest and Mary Keefe of Wood, say Dr. Douglas Lehmann failed to inform them of the type of pain medication they should have used.

The Keefes are seeking $2 million for personal injury and wrongful death.

Sturgis lawyer Mick Strain, who represents the plaintiffs, said he and the parents wouldn’t talk about the case until it is tried or settled. The file lists no attorney for the government.

[The type of pain medication is probably irrelevant, because the pain and the blood loss are independent.]

ADDIS ABABA, Ethiopia (UNICEF) — In a room filled with visiting dignitaries and members of the Ethiopian National Assembly, Tadeletch Shanko’s voice was whisper-quiet as she talked about the difficult subject of female genital mutilation/cutting, or FGM/C.

Ms. Shanko had performed FGM/C on girls for the last 15 years and underwent the procedure herself as a girl, with devastating consequences.

“I lost seven of my nine children in childbirth,” she said. “Because of the scarring I sustained, I was not elastic enough. All seven of them suffocated inside my womb.”

Raising awarenessMs. Shanko is no longer a supporter of FGM/C, as a result of a series of community dialogues on the physical and psychological harm caused by the practice.

She shared her story with the members of the Pan-African Parliament (PAP) Women’s Caucus, which convened in Addis Ababa late last month to assess the state of FGM/C across Africa – and to learn from the strategies that Ethiopia and other countries have put in place to eliminate it.

A key objective of the visit was to mobilize parliamentarian and state support for the elimination of harmful traditional practices, with a particular emphasis on female genital mutilation. Also on the agenda were ways to raise public awareness of FGM/C through the media; customary laws to introduce sanctions against the practice; and potential avenues for collaboration among various stakeholders in society.

Powerful testimonyThe parliamentarians heard powerful testimony from women and men whose lives had been tragically affected by FGM/C.

For Aregash Agegnehu, female circumcision – as the practice is also known – had never been a question of choice. “I was circumcised when I was a child. My daughter had to be cut as well,” she said. “It was inevitable.”

But since participating in in-depth community dialogues on the subject, Ms. Agegnehu no longer believes that FGM/C is a requisite part of being a woman.

“When I started engaging in community dialogue, I came to understand the harm of FGM, and now I have changed,” she said.

Cultural beliefsFemale genital mutilation is widely practiced by Muslims and Christians alike in Ethiopia, and official statistics suggest that almost three-quarters of women here have undergone the procedure. Forms vary widely by region but generally entail either a partial or total removal of the clitoris.

In the most severe form, infibulation, the labia are removed and the genitals sewn shut – barring a small hole for the release of urine and menstrual blood.

The predominant cultural belief is that circumcision is an essential pre-condition of marriage and motherhood. In many communities, an uncircumcised female cannot be recognized as a woman. Some feel that circumcision is a safeguard against promiscuity. Another common belief is that uncircumcised women tend to be inept at carrying out common household duties.

According to the World Health Organization, women who have undergone FGM/C are more likely to suffer from infertility, develop vaginal cysts and have recurrent bladder and urinary tract infections. FGM/C also increases the risk of childbirth complications and newborn deaths. It has no proven health benefits.

Worldwide, between 100 and 140 million girls and women are living with the consequences of FGM/C. In Africa, an estimated 92 million girls aged 10 and over have undergone some form of genital cutting.

Changed attitudesMany mothers fear that, without circumcision, their daughters will not fulfil the criteria for marriage or gain full acceptance in the community. Indeed, supporters of FGM/C often cite the fact that it is a long-held social norm. But such attitudes are changing. By the end of 2008, four of Ethiopia’s districts had publicly pledged to abandon FGM/C.

Mergieta Temesgen Ashebir, a religious leader who uses his influence to speak out against the practice, also spoke at the PAP conference. “According to the bible,” he said, “circumcision is only for boys, not for girls. There is no verse that states otherwise.”

[The bible is silent on FGC.]

Hon. Anab Abdulkadir, PAP Acting Chairperson and a member of the Ethiopian Parliament, pointed out the importance of understanding the root causes of FGM/C

“The demand is coming from where?” she asked. “It is coming from men. If there wasn’t a demand, there wouldn’t have been any supply. We have to … outlaw that demand.”

‘Not cast in stone’

...

Added Hon. Fatima Hajaig, a South African parliamentarian: “Cultural norms are not cast in stone. They develop from day to day. Our cultural value system changes as we go along. This business of ‘in the name of culture’ – I can’t accept that.”

UNICEF Ethiopia has been collaborating with partners on a number of advocacy efforts toward abandonment of FGM/C, including training community-dialogue facilitators and disseminating educational materials in various media. The parliamentary mission is the most recent effort in this direction.

Operation Abraham Coming to America?

By Gal Beckerman

In late August, the Centers for Disease Control and Prevention gathered hundreds of scientists and public health professionals in Atlanta for its biannual conference to discuss the issue of HIV prevention. One presentation, delivered by an Israeli doctor, managed to catch more media attention than any other, and to trigger the ire of a group of impassioned activists.

Dr. Inon Schenker’s proposition came in the form of a controversial question: Why not bring mass adult male circumcision to the Hispanic and African-American communities of America?

Schenker represents Operation Abraham, a group of Israeli doctors who gained expertise in circumcision by performing the procedure thousands of times, quickly and safely, on Russian-Jewish men who were raised outside Jewish tradition and immigrated to Israel in the 1990s.

Once evidence from clinical trials in Africa proved that circumcision could cut down heterosexual HIV transmission by as much as 65%, the Israeli doctors took their knowledge and innovative technique to Swaziland in southern Africa, where they began a pilot program last year. Now, Schenker thinks, America’s at-risk populations should be next.

On a recent afternoon, Schenker, a ruddy-faced and gregarious man, fresh from his presentation at the conference, sat down in a midtown Manhattan Starbucks and discussed the idea behind his project. He said he sees himself as a “matchmaker.”

“What clicked for me was bringing together the necessity of HIV/AIDS prevention with an Israeli expertise that is unprecedented. Our doctors had circumcised over 80,000 men [in Israel] in a very short time.”

Schenker’s American proposal came after the CDC announced last year that it was planning to fund a demonstration project in two community clinics that would, according to the CDC, “offer further insight into the feasibility and uptake of male circumcision among adult high-risk heterosexual males.”

“When this information reached us in Jerusalem, we said, hey, America has decided to move into adult male circumcision. Bravo,” Schenker said. “Could we support this effort in any way?”

The resulting abstract, which he presented in Atlanta, proposes to help train American doctors in much the same way as was effective in Swaziland: by working side by side and showing them how to circumcise efficiently. The innovation creates what Schenker called an “assembly line” technique, working in a team, using only local anesthesia and perfecting a “clamp” method of foreskin removal that uses forceps. The Israeli doctors boast that they are able to perform 30 or 40 circumcisions a day.

There are indications that Schenker might be getting ahead of himself. Though the CDC is pursuing the demonstration project, it has yet to fund it. And in an e-mail to the Forward, officials from the Atlanta-based agency also emphasized that they have “no current partnership with Operation Abraham” and that they are “not planning any CDC-led mass circumcision activities in the U.S. similar to what Operation Abraham has experience with.”

Another problem is that the overwhelming majority of HIV transmission in the United States is between men who have sex with other men. Circumcision has not been proved to make any difference in these cases.

[... nor in men who have sex with women in the US.]

Still, Schenker thinks he and his fellow doctors can save thousands of lives by helping prevent heterosexual transmissions. He pointed out that American taxpayers are currently funding adult male circumcision in Africa: Out of the nearly $50 billion approved last year by Congress for HIV/AIDS prevention and treatment in the continent, $17 million was set aside for such projects. And yet, a real debate had not been held in the United States about the benefits of the procedure. He wants to help start one.

[Bring it on!]

At the conference, Schenker was met with hostility from some quarters. A fervent movement exists in the United States that opposes circumcising infants. People who call themselves “intactivists” had a strong presence, and even though Operation Abraham is focused on adult circumcision, Schenker said he was targeted.

“They were very aggressive in their response,” Schenker said. “I think they’ve done a bad job for their case. If you have an argument, state it; let’s discuss. If you have an emotional agenda, you don’t bring it into a scientific conference. You bring it to the newspapers, you put it in blogs. But not in a scientific conference. Science is science. Base yourself on evidence.”

[He doesn't mention what triggered the "aggressive response" - a slide of a naked intact man, his body painted to resemble an elephant, with the words "Yes, circumcise me please" added - a sentiment the man himself would almost certainly have disagreed with, and a treatment of a whole class of people - intact men - comparable with anything in "Der Sturmer" in 1933.]

David Wilton is a San Francisco-based lawyer who maintains a blog, Male Circumcision and HIV, that is widely read by intactivists. His only explanation for Operation Abraham’s motives is a cynical one: “It’s an effort to gobble up HIV-AIDS funds that is going into prevention efforts.”

The other difficulty Schenker must confront arises from taking a technique that was perfected while performing circumcisions for religious purposes and applying it to health needs. He sees this as “the very essence of innovation, the ability to take something that was closed within the religious domain and bring it to the outer world.” But others, Schenker acknowledged, could be led by “ignorance or cruelty or antisemitism” into assuming that his group had some kind of missionary motive.

The name, Operation Abraham, doesn’t help. Schenker said that there were internal debates about whether to change it. “Perhaps those who are not very, very versed in history and the Bible could misinterpret the name to relate to one religion or two religions or religion in general,” he said. But for him, Abraham is not referenced as a religious figure so much as “the first surgeon who circumcised not only himself, but his two sons.”

The blurring of these lines might create problems for Schenker and his venture. Eli Ungar-Sargon, a young filmmaker who was raised Orthodox but has made a documentary film, “Cut,” that questions the practice of circumcision, wondered if the two motivations, health and religious, were actually more intertwined.

“There has always been this subterranean desire to demonstrate the relevance of our traditions” Ungar-Sargon said, referring to the Jewish community, “whether it’s saying that eating kosher is healthy or the prohibitions around sex during a woman’s menses is healthier. This sort of logic comes from a place of apologetics, and it’s a very disturbing thing to me. It’s also a very weak argument.”

Schenker doesn’t think so. To him, the focus on Operation Abraham’s Jewishness or Israeliness is unfair and a distraction.

“If I was a New Zealander who for some historical reasons had identified that dozens of his countrymen were surgeons who had an experience with circumcision that no other country had, you would have no problem by saying New Zealanders are coming to teach Americans this helpful technique,” Schenker said. “That would flow without any reaction or emotion whatsoever. So what can we do that the country with that skill happens to be Israel?”

[Ironic he should pick New Zealand. Almost all boys were circumcised there 50 years ago, but they found it did no good and it has virtually stopped. New Zealand doctors "hated doing them and were glad to give it up."]

Two weeks late - if it had been pro-circ it would have been headline news next day

Doctors circumspect on circumcision

LOUISE HALL HEALTH REPORTER

PARENTS who want to circumcise their newborn son should wait until he is old enough to make his own decision, Australia's peak body of pediatricians says.

The Royal Australasian College of Physicians will not change its policy against circumcision despite mounting evidence that the procedure can prevent the spread of HIV and other sexually transmitted infections.

[Yet again, a pro-intact statement undermined before it has even been properly stated. No mention of the RACP's discussion of the uselessness of circumcision against HIV in the Australian context.]

A long-awaited position statement by the college's pediatrics and child health division released last month differs from the previous policy, issued in 2004, by acknowledging that circumcision does have some medical benefits, such as protection against urinary tract infections in infants, HIV transmission and penile cancer.

[This is simply not true. The 2002 statement mentions all of those and rebuts them. The SMH seems to be taking Morris's word for this.]

But it says the potential complications of the surgery and anaesthesia, such as infection and bleeding, mean any benefits ''do not warrant a recommendation of universal circumcision for newborn and infant males''.

''We do not delay childhood vaccination until a child can consent, but curiously the summary recommends such a delay of this 'surgical vaccine','' Professor Morris said.

The recommendation to delay circumcision was a covert way of discouraging it, he said.

''The operation will no longer be as convenient, quick, cheap, low risk, without memory, but will instead be a more complicated procedure, often necessitating use of a general anaesthetic [only for a child - it can be done under local to a consenting adult], which carries risks, will cost more, with cost and time needed representing a greater drain on medical resources, all of which will mean it will less likely be undertaken,'' he said.

Circumcisions are not performed in most Australian public hospitals unless there is a medical need. Most circumcisions involve religious customs, particularly Jewish and Muslim.

The chairman of the college's circumcision working group, David Forbes, of the University of Western Australia's school of pediatrics, said the college was not anti-circumcision.

Delaying it until the child was old enough to make an informed choice was a ''reasonable option'' the statement says, but the college accepts that parental choice ''should be respected''. In that case, the procedure should be delayed until six months of age and performed under a general anaesthetic, it says.

The key point of the recently released RACP statement on circumcision is that the RACP believes that at the present time there is not evidence to support routine circumcision of newborn and infant males.

Your article sends a dangerous public health message that circumcision prevents HIV transmission. It is vital that everyone engage in safe sexual practices such as condom use, whether circumcised or not.

Recent reports of circumcision offering some protection against HIV infection in Africa relate to circumcision of adult males, not of infants. Further the stated benefits of protection against urinary tract infection are marginal, and do not justify mass circumcision. Our changing understanding of the relationship between urinary tract infection and chronic renal disease further weakens the case for routine circumcision.

There is evidence that circumcision does result in memory of painful experiences, and is not quite as simple and low risk as your report states.

The Colleges’ recent statement is not anti-circumcision, but clearly states that parents should be informed of risks and benefits, and then supported in their decision. When circumcision is undertaken it should be with appropriate anaesthesia, and by a skilled operator who can minimise the risks of side effects.

The option of delaying the decision to circumcise is one way of dealing with the ethical and potential legal issues of undertaking an elective procedure on a minor. The procedure is not to be equated with vaccination, either in its delivery or in its effectiveness.

It should be noted that Professor Morris, quoted in your report, is not a member of the RACP and is not and has not been engaged as a reviewer for the College.Yours faithfully,

Baby died of 'natural causes' after circumcision at Golders Green Synagogue

By Tristan Kirk »

A JEWISH baby boy died from natural causes after a circumcision procedure in Golders Green, a coroner has ruled.

Amitai Moshe was just a week old when he underwent the traditional operation at Golders Green Synagogue on February 1, 2007.

Today, Coroner Andrew Walker ruled the procedure had nothing to do with the boy's death, with was caused by sudden infant death syndrome, commonly known as cot death.

Amitai, of Sandringham Road, Golders Green, collapsed in his mother Yotvat Geva-Moshe's arms more than 30 minutes after the procedure, and turned blue while bleeding from the nose and mouth as guests at the service rushed to help.

He was taken to the University College Hospital but was declared dead eight days later.

Early speculation had linked the baby's death to the circumcision, which was carried out by a member of the Initiation Society, but that theory was categorically ruled out by the coroner at Hornsey Coroners Court.

Mr Walker said: “I am satisfied to say the death was as a result of a naturally occurring disease process which simply ran its course.

[And that disease process was...? SIDS is a description of a mystery, not a known disease with a natural course.]

“Any connection with Amitai's tragic death and the circumcision itself can be ruled out and I accept the circumcision was skillfully and deftly undertaken.

“There can be no suggestion that the Rabbi was in any way at fault or to blame for this tragedy.”

Professor Peter Fleming, a world leading expert on sudden infant death syndrome, gave key evidence to the hearing and said in his opinion the circumcision did not contribute to the baby's death.

He said: “With the circumcision itself, I can't think of any mechanism that would be responsible.”

After the ruling, Jonathan Goldberg QC, who represented the Initiation Society, hit out at critics who had tried to link the circumcision procedure and Amitai's death.

He said: “This verdict puts paid to those ill-intentioned people who would have tried to use this tragedy to attack Jewish circumcision.

“Professor Fleming, a world renowned expert, demonstrated conclusively that the death was a freak occurrence due to sudden infant death syndrome, wholly unrelated to the circumcision.”

Amitai was rushed to hospital after the collapse by Orthodox Jewish ambulance service Hatzola, a volunteer force established in Golders Green nearly 30 years ago.

Although the organisation was cleared of any blame for Amitai's death, David Segal, one of its trustees, told the hearing the organisation had “learnt a lot” from Amitai's death and reviewed training procedures for volunteers and what equipment is carried in its ambulances.

It has also appointed a medical director to help it prepare for any future rare cases it has to deal with, such as sudden infant death syndrome.

Amitai's parents were not present at the inquest, and Mr Walker said in their absence: “I know of all people nothing I will ever be able to say will be enough to comfort them for this loss.”

CHARITY WARNS OF MALE CIRCUMCISION RISKS

A national charity has called for wider awareness of the risks of circumcision, as the inquest is held into the death of a 16-day-old baby following a religious ritual two years ago.

Amitai Moshe died in 2007 following a ritual circumcision in North London and the inquest into his death began at Hornsey Coroner's Court on Monday.

The inquest follows one in Windsor earlier this year which concluded that baby Celian Noumbiwe had bled to death within hours of a circumcision at a doctor's surgery in Reading.

Many parents who consider circumcision necessary for ritual reasons believe that the operation is harmless in early infancy, and that it will bring benefit to the child.

However, men's health charity Norm-UK believes that this position is not supported by experts.

Gordon Muir, a consultant urological surgeon at King's College Hospital, who spoke out about circumcision at Norm-UK's conference last year, said: "There is no evidence that circumcising children has lower risk than carrying out the same procedure in adults and no medical benefit can be shown for baby boys in the UK having this procedure unless there are significant abnormalities of the foreskin.

"While the risk of major tragedies such as this is very low, I see many men who have suffered years of trauma and anxiety due to badly performed circumcisions they never needed for medical reasons, or consented to."

Jack Cohen a reproductive biologist who is to become Norm-UK's third patron, said: "Jewish law contains an exemption for families who have suffered deaths from the surgery, so it has long been known that circumcision can kill.

"Why should we continue to put boy's lives at risk for an ancient tradition of tribal marking and social control?"

Dr John Warren, founder of Norm-UK said: "Circumcision-related deaths in the West are rare but not as rare as the public think... as well as the two deaths investigated in England this year and another in 2006, two baby boys bled to death in Italy in summer 2008, and one in Ireland in 2003. We believe there are other cases which have passed under the radar due to the political sensitivity of the issue."

An analysis of national census religious data reveals that at least 19,000 boys could be circumcised each year in the UK. In 1993 (when circumcision rates would have been much lower) The Independent newspaper, reporting the death of baby Boma Oruitemeka, stated that more than 100 boys from babies to teenagers were treated each year for life-threatening circumcision complications.

In an attempt to find out the current picture, this year Norm-UK made freedom of information requests to hospitals across England. To date only a few have supplied the data requested.

Norm-UK said that London's Great Ormond Street hospital was one of the hospitals that initially seemed reluctant to provide the information requested. However, when the charity escalated its request the hospital revealed that over the past five years it had treated, an average of almost two boys each week for complications of circumcision in the community. Yet no child protection reports are on record since 2005.

Child protection experts now also recognise male circumcision as a potential source of harm to a child and the London Safeguarding Children Board's child protection procedures state that "Poorly performed circumcisions have legal implications for the doctor responsible". The guidelines add: "If a professional in any agency becomes aware, through something a child discloses or other means, that the child has been or may be harmed by circumcision, a referral must be made to [local authority] children's social care".

Norm-UK is a registered charity, founded in 1995, dedicated to the education of the public and the medical profession about the foreskin. For more information, go to www.norm-uk.org.

Circumcision baby inquest: the latest

Andrew Walker, the coroner hearing the inquest on the death of the baby Amitai Moshe, has ruled that there should be a change in wording in the pathologist's report written after the baby's death in February 2007.

Evidence given at the Hornsey Coroners' Court inquest yesterday indicated that the baby boy was in all probability clinically dead at Golders Green Synagogue, where his brit had been performed earlier. He was not pronounced dead until eight days later, at University College Hospital.

Today the coroner ruled that the pathologist's report should no longer say that the baby's collapse "immediately followed" his circumcision. The word "immediately" has been removed.

[The pathologist who performed the post-mortem was not called. A circumcision interest group, the Initiation Society, was represented, but not the crown or the baby.]

The baby's parents gave evidence yesterday and affirmed their belief that the death was not as a result of the brit.

[Clearly, this is a collaborative exercise in getting circumcision off the hook.]

Other evidence today came from London ambulance staff who outlined what medical help could have been given to the baby had he been under their care following his collapse.

In fact he was taken to hospital by the strictly Orthodox ambulance service, Hatzola, two of whose members are giving evidence today.

Circumcision baby may have died in shul

A London inquest heard today that Amitai Moshe, the baby who died eight days after his brit in Golders Green Synagogue, may, in fact, have clinically died at the shul itself.

Amitai was circumcised on February 1 2007 but shortly after the ceremony he began to turn blue and blood was seen around his mouth and nose.

Two medically trained guests and the mohel attempted to resuscitate him.

Hatzola, the strictly Orthodox ambulance service, and the London Ambulance Service were both called and Hatzola arrived first, taking the baby to the Royal Free Hospital. He was transferred to the University College London (UCH) where he died on February 9.

Today, the inquest heard from Amitai’s parents Ran and Yotzvat, mohel Rabbi Moshe Perry, who conducted the brit, and doctor Simon Cohen and dentist Philip Freiberger, who both witnessed the brit.

While questioning Dr Cohen, who attempted to resuscitate Amitai, Jonathan Goldberg QC, representing the Initiation Society, said: “This baby may have been clinically dead because there was no pulse and no breathing. The baby was probably dead before it got into the ambulance.”

Dr Cohen replied: “I think that is highly likely. He didn’t have circulation or respiration.”

Questioning further, coroner Andrew Walker, asked: “Is it more likely than not that he died in the synagogue?” Dr Cohen responded: “The answer has to be yes.”

The court also heard the tragic details of Amitai’s death from his parents.

His mother, Yotzvat, said that Amitai had suffered a slight cold the night before the brit, but appeared healthy on the day so she did not inform the mohel. It was only after the ceremony, when she began to breastfeed Amitai that she noticed something was wrong.

“He was uncomfortable and moving around,” she said. “He was crying and I stopped. Then he relaxed and was having milk normally. He stopped and I thought he fell asleep. Then I saw blood on my shirt. I thought it was mine but I saw blood from his nose. His colour was yellow.”

Rabbi Perry said that had he known about the cold, he would have asked a GP to inspect the baby to see if the brit should go ahead.

South Africa's leaders must espouse sensible, scientifically based advice about AIDS and put in place programs that seek to both treat and prevent the disease. That means expanding efforts to prevent mothers from infecting their babies, discouraging people from having multiple sex partners and offering circumcision to men, a relatively simple surgical procedure proved to have greatly reduced the risk of infection in South Africa.
[In South Africa, circumcising 1,546 men may have protected 25 men from infection within a period of less than two years.]

In South Africa, women, especially very young women, are three to five times more likely to be infected than men because of rampant sexual coercion and violence. They cannot control the number of partners their men have and may have more than one themselves just to survive, often for economic reasons.

Babies are infected because women lack access to the necessary health services and, more important, H.I.V. prevention in the first place. The little evidence available on adult male circumcision indicates no protective effect for men’s partners, and it may, in fact, affect women negatively.

A sustainable approach to ending South Africa’s epidemic requires putting women at the center of H.I.V. prevention efforts by ensuring access to female condoms, comprehensive sexuality education for all young people, and full protection of girls’ and women’s human rights.

Escaping the Somalian desert

By Keily Oakes

Desert Flower, which has premiered at the Venice Film Festival, tells the incredible journey of Waris Dirie, the model-turned-campaigner against female genital mutilation.

Although Dirie's story is full of drama - fleeing an arranged marriage at the age of 13 and eventually finding herself in London - it is the revelation that she was circumcised as a very young girl that gives the film its emotional centre.

While based on her autobiography, the movie has taken a degree of artistic licence, becoming a strange blend of drama and comedy, with star turns from Sally Hawkins, Timothy Spall and Juliet Stevenson.

But the central message is harrowing. It is difficult to absorb that female circumcision is a practise that continues in great numbers in Africa, and around the rest of the world.

Sir Elton 'sent packing'Dirie, who is helping to promote the film, is undoubtedly a strong woman, but also confrontational and untrusting in most things she does.

Director and screenwriter Sherry Hormann had the difficult task of persuading her that she would do her story justice.

Sir Elton John had already been sent packing with a flea in his ear after buying the rights to her story and sending along a screenwriter, to whom Dirie took an instant dislike.

With Hormann sitting next to her in Venice, Dirie does not hold back with her first reaction to seeing the film.

"This woman destroyed me," she says.

"When I had finished watching the movie I felt disturbed, I felt sad, angry, I felt really sick to my stomach. I had to run away to the desert for two weeks. It was the only way that could bring me back to sanity."

But she adds: "The movie was what I expected, to have the message, and if no-one can feel this movie I don't know what will move the hearts of the world".

Hormann interjects: "Waris originally said, 'you have to make me a promise, I do not want a solely political, female genital mutilation movie. I want to be entertained, I want young kids to see this movie and to laugh and to cry and to be entertained'.
...

Dirie made a powerful speech to the United Nations as she began her campaign to highlight the brutality of female genital mutilation. But she quickly fell out with the organisation, getting frustrated with its sheer size and lack of pressure on female issues.

So it was left to Hormann to give advice on what the average person can do build awareness of the problem.

"Look to your neighbourhoods, because immigrants carry the tradition.

...

"In New York City 40,000 girls a year are mutilated. I think if you get a feeling it is happening, just talk to them or call the police."

[40,000 a year? That would be 109 every day. There were 122,700 births in New York city in 2005, of which about 61,500 would be girls. That's nearly two girls in every three suffering FGC!]

Potential key to AIDS vaccine discovered: study

CHICAGO (AFP) – US researchers have discovered two powerful new antibodies which could hold the key to achieving a viable AIDS vaccine, according to a study published Thursday in the journal Science.

The antibodies are produced naturally by a minority of people infected with HIV and are able to neutralize a high percentage of the many types of the virus currently in circulation worldwide.

Researchers in California believe they can create an effective vaccine if they are able to stimulate the body to produce such "broadly neutralizing" antibodies before exposure to HIV.

"The findings themselves are an exciting advance toward the goal of an effective AIDS vaccine because now we've got a new, potentially better target on HIV to focus our efforts for vaccine design," said Wayne Koff, senior vice president of research and development at the International AIDS Vaccine Initiative.

"And having identified this one, we're set up to find more, which should further accelerate global efforts in AIDS vaccine development."
...

[And the nearer we get to a vaccine, the less useful circumcision is - especially for newborns.]

CURRENT COLLEGE POSITION ON CIRCUMCISION

The Paediatrics & Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on routine circumcision of newborn and infant boys for doctors who are asked to advise on or undertake the procedure and to assist parents who are considering having this procedure undertaken on their male children.

Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years and it remains an important ritual in some religious and cultural groups. In Australia and New Zealand, the circumcision rate has fallen considerably in recent years and it is estimated that currently around 10-15% of newborn male infants are routinely circumcised. [... in Australia; much less in New Zealand]

Circumcision is now generally performed with local or general anaesthesia, and when the procedure is undertaken for a medical indication this is usually outside of the neonatal period.

When considering routine infant circumcision, ethical concerns have focused on recognition of the functional role of the foreskin, the non-therapeutic nature of the operation, and the psychological distress felt by some adult males circumcised as infants. The possibility that routine circumcision contravenes human rights has been raised because circumcision is performed on a minor for non-clinical reasons, and is potentially without net clinical benefit for the child.

Recently there has been renewed debate regarding both the possible health benefits and the ethical concerns relating to routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, and in adults HIV infection and cancer of the penis. The frequency of these conditions, the level of protection offered by circumcision and complication rate of circumcision do not warrant a recommendation of universal circumcision for newborn and infant males in an Australian and New Zealand context.

After extensive review of the literature the RACP does not recommend that routine circumcision in infancy be performed, but accepts that parents should be able to make this decision with their doctors. One reasonable option is for routine circumcision to be delayed until males are old enough to make an informed choice. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. In the absence of evidence of substantial harm, parental choice should be respected. [So parents may authorise minor harm?]

If the operation is to be performed, the medical attendant should ensure this is done by a competent surgeon, using appropriate anaesthesia and in a safe child-friendly[?] environment.

27 August 2009

N.B. The full RACP Circumcision policy will be made available on the RACP website once the current review has been completed.

Body to 'get rid of' anti-circumcision NGOs

The National House of Traditional Leaders has vowed to continue with the customary circumcision of young Xhosa and Sotho men, and has warned "intrusive NGOs" opposed to the practice to stay away.

The House of Traditional Leaders said circumcision had been done for "hundreds of years" and would continue for "hundreds more".

It threatened to "get rid of intrusive NGOs that have been vying to do away with our custom".

But experts said if the practice continues it might have "unpleasant effects on the lives of young men" and religious groups claim it is just "pure nonsense".

John Smyth, of the Justice Alliance of SA, warned that, as currently practised, the custom should not be done.

"If (circumcision) continues to be performed, specifically in a manner which violates human rights, there might be a backlash and it would be better if it reaches extinction," he said.

But traditionalists are adamant the practice is "here to stay".

"It will not come to an end, never. We acknowledge the problems attached to our beloved custom, but we will not give it up.

"The intrusive NGOs and groups are in for a real fight because they do not know anything about the importance of (male) circumcision," said Chief Gcinikhaya Gwadiso, head of the house's national campaign for safe initiation schools.

Gwadiso was referring to anti-circumcision groups such as the National Organisation of Circumcision Resource Centres and the National Organisation to Restore Men, which have openly spoken out against circumcision.

The custom, called ulwaluko (initiation) and symbolising the passage of a boy into manhood, was pitted against religion and science when young initiates began to die while in the bush in the Eastern Cape.

Pastor Leon de Villiers, of the Seventh Day Adventist Church, said the traditional rite had no purpose. He said: "It's not valid anymore. Today everything should be done spiritually and no mutilation of the body is necessary."

The death toll among initiates has increased over the years and inexperienced traditional surgeons and nurses, and negligence have been cited as causes.

Interventions by the government and interest groups seeking safer alternatives were met with furious reactions by individuals who felt it was an "intrusion" and not a "customary correct" way of doing things.

But as more initiates started dying in other provinces some young men finally gave in to the safer, modern form of circumcision.

However, those who were circumcised in hospitals were then subjected to humiliation and harassment, and shamed by not being considered "men", as opposed to those who had gone to the bush. Gwadiso said although the traditional body supported safe and healthy circumcision, doing it in hospital was "taking it too far".

"Things have to be done the correct way, or not done at all. [All right, we'll have Option B.] Circumcision is part of a long list of traditional rites and has been done the same way for a very long time; alterations tend to clash very badly with our ways. We can't support circumcision in hospitals," he said.

However, the situation has seen many young boys defying their parents' wishes and converting to other religions, consequently avoiding being circumcised.

Thamsanqa Totana is a 21-year-old Xhosa man from Worcester who converted to Rastafarianism. Totana said: "I have been a rasta since 2004 and am truly against being circumcised. I do not agree with the tradition because it's at odds with my beliefs. My family has tried to convince me to change but I won't, I don't want to anger God."

Totana said he was never forced to go to the bush, which was not the case for 21-year-old Bonani Yamani who launched a civil case against his father this year for allegedly forcing him to be circumcised in 2007 and then eat his severed foreskin.

Health experts said Yamani's case, the first of its kind in South Africa,was a "clear indication of the strain felt by elders and the youngsters" and that the need to change was vital.

Dumisani Gabula, of NGO Partners in Sexual Health, said: "We need to move on with the times. The younger generation has plainly shown that 'our elders need to catch up'.

"Those boys face dire health and sexual danger out there. Parents need to adapt to new and improved strategies to ensure that the (circumcision) process goes smoothly and implement a few changes," Gabula said.

Status of CDC Male Circumcision Recommendations

Some recent reports have speculated about the Centers for Disease Control
and Prevention’s (CDC’s) upcoming public health recommendations on
male circumcision for HIV prevention in the United States.

It is
important to note that the recommendations are still in development and
CDC has made no determination at this time about the final content. CDC
is employing a deliberative, evidence-based process for developing the
circumcision recommendations, which allows for both external and internal
CDC experts to provide input. CDC will also publish draft recommendations
for public comment before the content will be finalized.

With respect to
infant circumcision, it is important to recognize that many options are
still being considered in this process, including simply recommending
that health-care providers educate parents about the potential benefits
and risks to ensure that parents have the information they need to make
an informed decision.

In developing its recommendations, CDC is also
considering whether circumcision should be recommended for heterosexual
adults at high risk for HIV infection in the United States, as well as
whether there is sufficient scientific evidence to make any
recommendations for men who have sex with men.

Whatever the content may
include, CDC’s final circumcision recommendations will be completely
voluntary. While CDC has not yet determined if male circumcision should
be recommended for any population, ultimately the decision will rest with
individuals and parents.

[Yes, adult men might consult with their parents if they wish - most would prefer to make such an intimate decision without the advice of people who probably know less than they do.]

CDC’s public health imperative is to provide
the best possible information on the risks and benefits to help inform
those decisions.

Keep America's baby boys intact

By Jennifer Margulis

On Tuesday the Centers for Disease Control and Prevention held a meeting in
Atlanta as part of a four-day conference on HIV prevention to discuss how to
urge non-circumcising communities in American to circumcise. At the same
time, the American Academy of Pediatrics, which has long remained neutral on
the subject, is currently revising its guidelines in favor of circumcision.
Growing up Jewish in America, I never questioned circumcision. But now,
after having children and seeing how grown men in my life continue to suffer
psychologically because of a procedure done to them as infants, I've come to
believe that circumcision is not only unnecessary, it's a painful and
traumatizing procedure that should not be done in infancy, if at all.

Deciding whether to circumcise is a decision that every American parent of a
boy faces, though the majority simply choose to follow the doctor or
hospital's recommendation.

According to an Aug. 24 article in the New York Times, approximately 79
percent of all adult American males are circumcised. According to Intact
America, a nonprofit organization trying to stop routine circumcision in
America, circumcision is the most common surgery performed in America and it
happens to more than 1 million newborns a year, more than 3,000 times a day,
or once every 26 seconds.

Before my brother Zach's wife gave birth to their third child, I started
receiving frantic emails from a 28-year-old male relative whom I'll call J.
"Do you know if they are planning to circumcise?" J. wrote me. "Could you
find out about it? Could you tell them not to? Could you talk to them?" As
the due date approached, the messages become increasingly desperate, as if
J. felt that circumcision were a matter of life and death. At the same time,
J. was ashamed for being so worried. He asked not to tell anyone that he was
inquiring; he said he felt embarrassed and couldn't talk to my brother
directly. He begged me not to mention to his mother, especially, how worried
he felt about Zach's baby.

J. himself is circumcised. Circumcision is part of my family's cultural
heritage.

...

Yet it is not for traditional reasons that health officials want to see an
upswing in American circumcisions. Recent health studies in Africa suggest
that circumcised heterosexual men are less likely to get an HIV infection
than their non-circumcised counterparts. Circumcision proponents also argue
that urinary tract infections are less likely among circumcised men, and
that it is necessary for cleanliness. They discount the pain involved in the
procedure and argue that it creates no lasting damage.

Those in favor of circumcision for medical reasons are wrong. First of all,
the procedure is painful, even with the administration of anesthesia. Anyone
who has ever witnessed a circumcision (you can watch one on the internet if
you don't believe me) and heard the high-pitched scream of a newborn having
the tip of his penis cut off knows that this surgery causes terrible pain.
For the week that the cut is healing, a baby is peeing and defecating on a
raw, open wound. Circumcision is also dangerous. Just this past March a jury
in Atlanta awarded $1.8 million in damages to a boy's parents after a
seriously botched circumcision.

It's also a procedure that causes lasting regret in some grown men. J. feels
so badly about being circumcised that he is on a campaign to stop all of us
having children from circumcising. Other men I know wish their parents gave
them the option to choose instead of forcing them to undergo a painful
procedure as one of their earliest life experiences. If there really is a
correlation between circumcision and HIV prevention, then we should let
adult men choose to have the procedure done once they are sexually active.

My brother's baby turned out to be a girl. But my own son is not circumcised
and if the baby I am carrying now, due in October, is a boy he will not be
either. Forced circumcision of newborns is wrong. Let's not impose trauma on
newborns and instead give adult men the right to choose.

Jennifer Margulis is a professional writer and the co-author of "The Baby
Bonding Book For Dads." Read more about her.

Circumcision to prevent HIV infection in America

Public health officials are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS.

...

He and other experts acknowledged that although the clinical trials of circumcision in Africa had dramatic results, the effects of circumcision in the United States were likely to be more muted because the disease is less prevalent here, because it spreads through different routes and because the health systems are so disparate as to be incomparable.

Clinical trials in Kenya, South Africa and Uganda found that heterosexual men who were circumcised were up to 60 percent less likely to become infected with H.I.V. over the course of the trials than those who were not circumcised.

There is little to no evidence that circumcision protects men who have sex with men from infection.

Another reason circumcision would have less of an impact in the United States is that some 79 percent of adult American men are already circumcised, public health officials say.

My first thought is that I really would like to see the cost vs. benefit analysis; the United States is not KwaZulu-Natal. The article notes white males tend to be circumcised already, which is interesting because American white male HIV prevalence rates seem to be somewhat higher than British rates (compare & contrast). This is important because while American men are mostly circumcised, most British men are not. The point is not that circumcision has no effect, but that on the margins its return is probably far less when you have a population which is already has low rates of infection. As I have noted before, circumcised South Korea and uncircumcised Japan have the same HIV infection rates, on the order of ~0.1%.

In the United States non-Hispanic white men have the highest rates of circumcision, followed by black men, and then Hispanics. But here are the ethnic-racial proportions of HIV infected individuals in the United States:

Hispanics are slightly overrepresented (as they are somewhat less than15% of the population), but blacks who are 12% of the population are heavily overrepresented. Around ~25% of HIV transmission in the USA occurs via high risk heterosexual sex, a far lower proportion than in Africa.

This is really an issue with complex parameters. One-size-fits-all answers are frankly dumb and short-sighted. I've gotten some grief when I've offered that male circumcision may be part of the solution in regions where HIV infection rates are on the order of 1/3 of the population. The cost vs. benefit seemed to make this a plausible line of thinking, but in the United States I don't see it. As it happens American whites have higher HIV prevalence rates than many European populations, so in that case it isn't circumcision where the low hanging fruit is likely to be. In the United States there is a particular problem among homosexuals and blacks. As noted above most are skeptical about circumcision's ability to reduce risk when it comes to male-male sex, but it might have some benefit for black Americans. Look at the odds:

To date, over 225,000 African Americans have died of AIDS - nearly 40% of total deaths - and of the more than 1 million people living with HIV in the United States of America today, around half are black. And yet, as a racial group, African Americans represent just 13% of the US population. The estimated lifetime risk of becoming infected with HIV is 1 in 16 for black males, and 1 in 30 for black females, a far higher risk than for white males (1 in 104) and white females (1 in 588).

Circumcision doesn't protect gays from AIDS virus

By MIKE STOBBE

ATLANTA - Circumcision, which has helped prevent AIDS among
[perhaps 73] heterosexual men in Africa, doesn't help protect gay men from the virus, according to the largest U.S. study to look at the question.

The research, presented at a conference Tuesday, is expected to influence
the government's first guidance on circumcision.

Circumcision "is not considered beneficial" in stopping the spread of HIV
through gay sex, said Dr. Peter Kilmarx, of the U.S. Centers for Disease
Control and Prevention.

However, the CDC is still considering recommending it for other groups,
including baby boys and high-risk heterosexual men.

[Baby boys are an "other group"?]

UNAIDS and other international health organizations promote circumcision,
the cutting away of the foreskin, as an important strategy for reducing
the spread of the AIDS virus. There hasn't been the same kind of push for
circumcision in the United States.

For one thing, nearly 80 percent of American men are already circumcised -
a much higher proportion than most other countries. Worldwide, the male
circumcision rate is estimated at about 30 percent.

Also, while HIV spreads primarily through heterosexual sex in Africa and
some other parts of the world, in the United States it has mainly infected
gay men. Only about 4 percent of U.S. men are gay, according to
preliminary CDC estimates released at the conference this week. But they
account for more than half of the new HIV infections each year.

Previous research has suggested circumcision doesn't make a difference
when anal sex is involved. The latest study, by CDC researchers, looked at
nearly 4,900 men who had anal sex with an HIV-infected partner and found
the infection rate, about 3.5 percent, was approximately the same whether
the men were circumcised or not.

Government recommendations on circumcision are still being written and may
not be final until next year, following public comment. CDC doctors and
many experts believe there is a good argument for recommending that baby
boys and heterosexual men at a higher risk for HIV be circumcised.

The definition of "high risk" is still being discussed, said Kilmarx,
chief of the epidemiology branch in the CDC's HIV division.

Circumcision is a sensitive issue laden with cultural and religious
meaning, particularly when babies are involved, Kilmarx acknowledged.

"It's seen by many as more than just as medical procedure," he said. It's
possible the government would just recommend better education for doctors
and parents about the procedure's benefits and risks, he added.

The prospect of the government promoting circumcision of infants has
already drawn fire from an advocacy group called Intact America. The
organization, based in Tarrytown, N.Y., parked a motorized billboard this
week outside the hotel hosting the HIV conference, displaying the message:
"Tell the CDC that circumcising babies doesn't prevent HIV."

Officials Weigh Circumcision to Fight H.I.V. Risk

By RONI CARYN RABIN

Public health officials are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS.

The topic is a delicate one that has already generated controversy, even though a formal draft of the proposed recommendations, due out from the Centers for Disease Control and Prevention by the end of the year, has yet to be released.

Experts are also considering whether the surgery should be offered to
adult heterosexual men whose sexual practices put them at high risk of
infection. But they acknowledge that a circumcision drive in the United
States would be unlikely to have a drastic impact: the procedure does not
seem to protect those at greatest risk here, men who have sex with men.

["Also"? If they were serious about preventing HIV, wouldn't adult men at high risk be their first priority?]

Recently, studies showed that in African countries hit hard by AIDS, men
who were circumcised reduced their infection risk by half. But the
clinical trials in Africa focused on heterosexual men who are at risk of
getting H.I.V. from infected female partners.

For now, the focus of public health officials in this country appears to
be on making recommendations for newborns, a prevention strategy that
would only pay off many years from now. Critics say it subjects baby boys
to medically unnecessary surgery without their consent.

But Dr. Peter Kilmarx, chief of epidemiology for the division of
H.I.V./AIDS prevention at the C.D.C., said that any step that could
thwart the spread of H.I.V. must be given serious consideration.

"We have a significant H.I.V. epidemic in this country, and we really need
to look carefully at any potential intervention that could be another tool
in the toolbox we use to address the epidemic," Dr. Kilmarx said. "What
we've heard from our consultants is that there would be a benefit for
infants from infant circumcision, and that the benefits outweigh the
risks."

[That is simply nonsense. The only possible benefit to infants is a one chance in 190 of it preventing a usually readily treatable urinary tract infection.]

He and other experts acknowledged that although the clinical trials of
circumcision in Africa had dramatic results, the effects of circumcision
in the United States were likely to be more muted because the disease is
less prevalent here, because it spreads through different routes and
because the health systems are so disparate as to be incomparable.

[The "dramatic results" amount, in total, to 73 circumcised men who might have been infected if their groups totalling 5,411 men had not been circumcised.]

Clinical trials in Kenya, South Africa and Uganda found that
heterosexual men who were circumcised were up to 60 percent less likely to
become infected with H.I.V. over the course of the trials than those who
were not circumcised.

["Up to 60%" is like "Up to 50% off" at sales - it's called "bait advertising" or "bait and switch".]

There is little to no evidence that circumcision protects men who have sex
with men from infection. Another reason circumcision would have less of an
impact in the United States is that some 79 percent of adult American men
are already circumcised, public health officials say.

[Put another way, circumcision has had no impact.]

But newborn circumcision rates have dropped off in recent decades, to
about 65 percent of all newborns in 1999 from a high of about 80 percent
after World War II, according to C.D.C. figures. And blacks and Hispanics,
who have been affected disproportionately by AIDS, are less likely than
whites to circumcise their baby boys, according to the agency.

[They get that result by pooling blacks and Hispanics: Blacks are circumcised almost as much as whites and get more HIV, Hispanics much less and get less. It's socioeconomic factors, not circumcision. Asians circumcise much less and get much less HIV.]

Circumcision rates have fallen in part because the American Academy of
Pediatrics, which sets the guidelines for infant care, does not endorse
routine circumcision. Its policy says that circumcision is "not essential
to the child's current well-being," and as a result, many state Medicaid
programs do not cover the operation.

The academy is revising its guidelines, however, and is likely to do away
with the neutral tone in favor of a more encouraging policy stating that
circumcision has health benefits even beyond H.I.V. prevention, like
reducing urinary tract infections for baby boys, said Dr. Michael Brady, a
consultant to the American Academy of Pediatrics.

He said the academy would probably stop short of recommending routine
surgery, however. "We do have evidence to suggest there are health
benefits, and families should be given an opportunity to know what they
are," he said. But, he said, the value of circumcision for H.I.V.
protection in the United States is difficult to assess, adding, "Our
biggest struggle is trying to figure out how to understand the true value
for Americans."

[After 120 years of doing it medically, and they still don't know that it's any good?]

Circumcision will be discussed this week at the C.D.C.'s National
H.I.V. Prevention Conference in Atlanta, which will be attended by
thousands of health professionals and H.I.V. service providers.

Among the speakers is a physician from Operation Abraham, an
organization based in Israel and named after the biblical figure who was
circumcised, according to the book of Genesis, when he was 99 years old.
The group trains doctors in Africa to perform circumcisions on adult men
to reduce the spread of H.I.V.

[This just underlines that circumcision is a Stone Age blood ritual.]

Members of Intact America, a group that opposes newborn circumcision, have
rented mobile billboards that will drive around Atlanta carrying their
message that "circumcising babies doesn't prevent H.I.V.," said Georganne
Chapin, who leads the organization.

Although the group's members oppose circumcision on broad philosophical
and medical grounds, Ms. Chapin argued that the studies in Africa found
only that circumcision reduces H.I.V. infection risk, not that it prevents
infection. "Men still need to use condoms," Ms. Chapin said.

[Broad philosophical grounds like, "Whose body is it?"]

In fact, while the clinical trials in Africa found that circumcision
reduced the risk of a man's acquiring H.I.V., it was not clear whether it
would reduce the risk to women from an infected man, several experts said.

[It was so clear that it doesn't protect women they stopped the study, and it may have shown that circumcision increased the risk.]

"There's mixed data on that," Dr. Kilmarx said. But, he said, "If we have
a partially successful intervention for men, it will ultimately lower the
prevalence of H.I.V. in the population, and ultimately lower the risk to
women."

[This is purely hypothetical, and could easily be overwhelmed by other factors, such as circumcised men pushing unprotected sex on women.]

Circumcision is believed to protect men from infection with H.I.V.
because the mucosal tissue of the foreskin is more susceptible to
H.I.V. and can be an entry portal for the virus. [This is still highly theoretical, and based on the assumption that it does protect.] Observational studies have found that uncircumcised men have higher rates of other sexually
transmitted diseases like herpes and syphilis, and a recent study in
Baltimore found that heterosexual men were less likely to have become
infected with H.I.V. from infected partners if they were circumcised.

Jurors in mutilation case sentence mom to 99 years

A Houston mother was sentenced to 99 years in prison on Monday for
severing her infant son's genitals in a 2007 attack she blamed on the
family dog.

Harris County jurors deliberated about two hours on Monday before
sentencing Katherine "Katie" Nadal, a former Anahuac cheerleader, the
maximum allowed for the charge of serious bodily injury to a child. Nadal,
28, was also fined $10,000. She will have to serve 30 years before
becoming eligible for parole.

In an emotional outburst during impact statements from five of the boy's
family members, Nadal shouted at Patches DeShazo, the child's aunt, who is
also his legal guardian.

As DeShazo chastised Nadal for hurting the boy, Nadal shouted back, "No I
didn't. I didn't hurt him, I failed him." Camden Gothia, the boy's father,
them jumped from his seat and shouted, "You abused him while he was still
in the womb!"
...

AIDS battle takes a tragic turn in Uganda

After a study showed that circumcision reduces the incidence of HIV infection in men, circumcision providers in Uganda have been enjoying brisk business.

The drumbeat for circumcision has been so loud that by December, when a document detailing the official “circumcision policy” is made final, authorities may have no reliable estimate of how many Ugandans have heeded the call. What’s more, Uganda’s born-again attempts to curtail a resurgent AIDS crisis would have been done no favors.

How did we get there? It’s complicated.

Uganda was long hailed as a beacon of hope in the AIDs battle, for its success in bringing down the HIV prevalence rate from double digits in the early 1990s to as low as 5 percent by 2001. Such was Uganda’s reputation that it soon became a global exemplar of what it took to credibly fight AIDS.

The problem is that the figure didn’t keep going down, with prevalence rates in some parts of the country now much higher than the national average of about 6 percent. And by some accounts that figure is inaccurate, as the rate is said to be rising fast.

Today, the Kampala government’s willingness to embrace mass circumcision as a viable tool in the AIDS battle captures the desperation that has come to define Uganda’s AIDS outlook. In fact, the hysteria says less about what can be done to control the situation and more about what was not done but should have been. The missed opportunities are staggering.

Nearly all households in Uganda, including mine, have lost someone to AIDS. For the younger generation of Ugandans, however, the stories of the human losses may sound distant, in large part because fewer people die of AIDS today.

With more Ugandans accessing treatment, the debilitating effects of the disease are no longer as obvious, much less imagined. The tough message that AIDS kills, the prevention-rich mantra that was responsible for Uganda’s old success, has been lost at the altar of a policy that subtly emphasizes treatment.

Some critics allege that health authorities in Uganda sold their souls to the wallets of the pharmaceutical companies, but it may well be that they simply took a success story for granted. The authorities deny both accusations.

Ugandan health authorities previously fought AIDS with an attitude that proclaimed the fear of AIDS was the beginning of wisdom.

The evidence shows that it worked, with millions of Ugandans embracing the so-called ABC, a strategy that called for abstinence or fidelity or the use of condoms. But somehow that message stopped being mainstream. What happened to all the street posters that preached prevention? Though it’s hard to say that ABC has reached its tipping point, and even as it remains clear that the old prevention messages no longer are nearly as ubiquitous as they once were, the conversation has suddenly turned to circumcision.

The resulting crusade makes a mockery of a serious situation, a campaign whose ideas fly in the face of common sense.

In America, most babies are circumcised at birth; in Uganda and elsewhere in Africa where circumcision is catching on, old men are undergoing the procedure to avoid catching HIV. It’s ridiculous. As a strategy, circumcision doesn’t inspire changed behavior, the very essence of ABC.

It discounts the idea that a once-high prevalence rate dramatically went down because more Ugandans were compelled to revise their sexual behaviors. Beyond preventing ABC, a circumcision-based strategy ignores why the rate is rising again.

Until circumcision’s actual benefits and limits are made clear to everyone, illiterate or not, a circumcision drive that’s linked to HIV prevention is bound to be a spectacular failure. The comedians in Kampala know it when they claim that circumcision can cure AIDS. They measure the pulse of the country.

THE controversial head of Birmingham Central Mosque has been reprimanded by the General Medical Council for circumcising a baby boy without the parents’ consent.

Dr Mohammad Naseem, from Handsworth, now has a black mark against his doctor’s licence for the next five years.

The General Medical Council (GMC) slapped the 85-year-old with an official warning for bringing the profession into disrepute over a catalogue of failings when giving the 11-month-old boy the snip.

But Dr Naseem is protesting his innocence and says he plans to take legal action against the GMC.

The baby’s mother lodged a complaint to the GMC in November claiming she was not fully informed about the circumcision at Dr Naseem’s surgery in Aston.

GMC inspectors decided that it was serious enough to warrant a warning – but Dr Naseem refused to accept it, electing a hearing to explain his side of the story.

The chairman of Birmingham Central Mosque, who last month accused the Government of covering up the 7/7 bomb attacks, went before a GMC Investigations Committee this month.

And they have also ruled the medic deserves a five year warning.

Miss Mandie Lavin, chair of the GMC committee, said: “The mother complained to the GMC and it was alleged that you performed a religious circumcision on her 11-month-old son in September 2007 without obtaining informed consent for the surgical procedure, and that you did not make an adequate clinical record of it. You also failed to provide appropriate information about the aftercare required and when to seek further medical advice from a GP, if necessary.

[And failure to do so could lead to the child's death from haemorrhage.]

“There is a handwritten note on the bottom right of the form which represents the only record you made of the surgical procedure... and it makes no reference of the fact that you prescribed antibiotics. The Committee is concerned that you did not inform the child’s GP that you had performed a circumcision, or that you had prescribed antibiotics.”

The warning will stay on Dr Naseem’s record until 2014, detailing to prospective employers and patients the failures in the baby case.

Dr Naseem, who is the main religious circumcision practitioner for circumcision on boys in the Midland Muslim community, denied all the allegations, saying the mother signed a statement that she understood what was taking place before he went ahead with the procedure.

“I am going to appeal against this decision and take legal action against the GMC,” said Dr Naseem. “The circumcision was straightforward and absolutely safe. Nothing went wrong.

“I explained to the mother and she signed a form. The father was not there and I believe there is now a rift between them. I do many circumcisions and I don’t deserve a warning.”

Circumcision not risk-free

Circumcision of boys is described by its proponents as a procedure free of
complications. But within the health care sector, the risks are well known.
A populist push for objectivity in this issue amounts to an abuse of those
most vulnerable, boys under the age of consent, according to medicos and
politicians, Peder Drott and Finn Bengtsson.

County council member Birgitta Rydberg (Liberal Party) held up the issue
of religious freedom against the UN Convention on the Rights of the Child,
and accused those physician groups involved of naivety, in the question of
the circumcision of boys under the age of consent (Brännpunkt August 4,
http://www.svd.se/opinion/brannpunkt/artikel_3302285.svd). This was an
extraordinary statement by a liberal politician who is not directly
affected by what individual boys can suffer within the Swedish health care
sector.

Besides the UN convention, the health care sector has allied itself with
the Nordic Association for the Needs of Sick Children, both of which
strongly affirm that child patients shall be informed of the basis for any
treatment given, and that they have a right to health personell trained in
pediatrics who can meet their physical and mental needs. Stated simply, the
child's integrity must be respected.

Consequently, through their professional organisations, Swedish pediatric
surgeons and doctors have questioned the serious breach of personal
integrity that occurs with the removal of a body part from a child, in
the absence of any reasonable consent.

When the interests of a child and an adult are in conflict, for example in
cases of abuse and pedophilia, we of course take the side of the child, by
criminalising such behaviours to protect the child. To then consider as a
social right the wishes of those parents who want to remove body parts,
without consideration for the child's consent, seems absurd.

The really serious concern is that circumcision of boys is described by
its proponents as a complication-free procedure. Furthermore, there has in
fact not been any conclusive scientific proof of a reduction in the
frequency of uterine cancer among female partners or of reduced rates of
HIV infection among circumcised men.

But the negative consequences of circumcision are well known within
the health care sector.

Stenosis [narrowing] of the meatus [urinary opening] can lead to kidney damage. In the worst cases
kidney function may cease, necessitating dialysis or transplantation.
Decreased glans sensitivity may be experienced as a "double condom". This
may contribute to an increased HIV transmission risk since a third condom
further reduces sensitivity. Also, the common complications of surgery,
including infection, impaired healing, injuries during the procedure, and
problems from anaesthesia, etc., cannot be ignored.

To us, it is a hypocritical stance, when debating this issue, to abandon a
boy from the neonatal period and throughout the years of childhood, by
demanding that the health care system be forced to participate in sexual
mutilation, solely at the behest of his guardian. A populist push for
objectivity in this issue in fact amounts to an abuse of those who are
most vulnerable, boys under the age of consent. An operation without
medical indications but with risks of irreversible injuries should not be
forced on juveniles - not by anyone!

PEDER DROTT Pediatric Surgeon and County Council
representative (Conservative Party)

Jury convicts mom in baby-mutilation case

Jurors on Friday convicted Katherine Nadal of serious bodily injury to a child, determining that she cut off her 5-week-old son’s genitals. The jury deliberated for about three hours.

Nadal shook her head as she heard the jury’s finding that she used a deadly weapon, an enhancement that may affect the punishment. Nadal could get up to life in prison.

Before adjourning late Friday, the jury of seven women and five men heard from Dr. Edmond Gonzales, a pediatric urologist at Baylor College of Medicine, as they consider a sentence.

Gonzales testified that the little boy, Holden, faces multiple and costly reconstructive surgeries that have no guarantee of success and will likely need lifelong counseling. Jurors are scheduled to hear more testimony Monday.
...

Bhisho team 'traumatised' by botched circumcisions

TRAUMATISED Bhisho officials believe that showing traditional surgeons the results of botched circumcisions may help prevent deaths among initiates.

The province’s health standing committee, led by ANC provincial Legislature member Mxolisi Dimaza, visited Nelson Mandela Academic Hospital and Mthatha General Hospital where injured initiates are being treated.

“I have never seen anything like this in my whole life … It was a bad sight indeed … gruesome. I did not sleep the whole night, but (stayed up) sobbing. We were really traumatised,” said Dimaza.

The multi-party committee embarked on the tour to find solutions following the deaths of 53 initiates this season.

Thirteen others suffered penile amputations, and about 40 young men are still being treated at the two hospitals.

“Apparently, some were taken very late to hospital and now doctors cannot do anything to help them. Their manhood is just falling off,” Dimaza said.

Other members – Congress of the People MPL Nkosinathi Kuluta and UDM MPL Max Mhlati – said, as men who had undergone the ritual circumcision, they knew exactly what pain initiates experienced .

“But what we saw at the hospital was worse,” said Kuluta. “It is traumatic and portrays the custom in a bad light.

“Although initially we planned to inspect injuries of seven initiates, seeing only two was more than enough. It was too much for us to bear.

“We were too traumatised and afraid to see others,” he added.

The committee plans to launch an awareness campaign aimed at curbing deaths and injuries caused by botched circumcisions – and part of it is having visuals and pictures of the injuries shown to traditional leaders, traditional circumcision practitioners, circumcision candidates and parents.

Dimaza said: “This will instill a sense of responsibility, care, awareness and vigilance.

“If one sees these pictures, they will understand the seriousness of the matter.”

Almost all circumcision-related deaths and injuries occur in Pondoland where the team said the custom had been “hijacked by children, infiltrated by those greedy for money and manned by criminals”, said Mhlati.

“It was shocking that 14-year-olds – only circumcised in December – were in other areas operating as traditional surgeons and nurses.

“Children have taken control of the custom in Pondoland while their parents have distanced themselves or adopt a wait-and- see approach.”

AmaMpondo monarchs, King Mpondombini Sigcau and his counterpart, King Ndamase Ndamase, feared their “nation would be wiped out or have non- reproducing young males if something was not done immediately”.

The committee, in consultation with traditional leaders, is looking at importing traditional surgeons and nurses from death- free areas in the province to Pondoland during circumcision seasons.

The committee is to table its report to the Legislature before the end of August and next month will visit schools in Pondoland speaking to boys, parents and teachers about the advantages and injuries of circumcision.

“I hope in the summer season there will be no more traumatic experiences,” said Dimaza.

The team also visited, Qumbu, Tsolo and Buffalo City. - By LULAMILE FENI, Traditional Affairs Reporter

Egypt makes first arrest over female circumcision

CAIRO (Mustafa Suleiman)

An Egyptian man has been charged with illegally circumcising a young girl on Thursday, making him the first person to face the law since Cairo criminalized the controversial practice of female genital mutilation, or FGM.

Ahmed Gad al-Karim, 69, was charged with inflicting injury on an 11-year-old girl after a local hospital notified the police when the young girl was brought in suffering from heavy bleeding following a circumcision.

The Upper Egyptian governorate of Minya, 600 kilometers south of Cairo, was told that the girl's mother gave Karim 150 Egyptian Pounds ($ 27) to circumcise her daughter, who remains in critical condition.

Karim said he performed the operation at the girl's house and said he had used a scalpel.

According to the World Health Organization and estimated 100 to 140 million females worldwide currently live with the consequences of FGM, which is internationally recognized as a human rights violation.
...

A Jury awarded $429,484 to an infant whose penis was allegedly
disfigured for life by surgery.

On Nov. 12, 2006, Evan Tank was circumcised by pediatrician [and mohel] Ralph Berberich, who accidentally cut the tip of Evan's penis. Plaintiff's
counsel claimed that Berberich failed to remove adhesions tethering
the foreskin to the glans, causing the glans to be pulled into the
clamp along with the foreskin. Hence the glans was cut off along with the
foreskin.

Berberich countered that penis trauma is a recognized complication of the
procedure and that Evan's parents had accepted the risk. The doctor argued
that, rather than an error on his part, Evan probably had an unusual
penile anatomy that caused his penis to be pulled into the clamp. [Blame the victim! And isn't a paediatrician supposed to know about, and look out for, "unusual penile anatomy"?]

Tail docking and ear cropping banished from Banfield pet hospitals

U.S. dogs achieved a major victory for their health and well-being as the largest national veterinary practice, Banfield The Pet Hospital, announced that it will no longer offer tail docking, ear cropping or devocalization of dogs in its hospitals. The decision was made by an internal Medical Standards Board of experienced veterinarians.

Banfield is the exclusive provider of veterinary services for the Petsmart pet supply chain. The Portland, Oregon based company has 730 hospitals and 2,000 veterinarians nationwide.

“After thoughtful consideration and reviewing medical research, we have determined it is in the best interest of the pets we treat, as well as the overall practice, to discontinue performing these unnecessary cosmetic procedures,” said Karen Faunt DVM, MS, DACVIM, vice president for medical quality advancement for Banfield. “It is our hope that this new medical protocol will help reduce, and eventually eliminate, these cosmetic procedures altogether.”

The veterinary hospitals will continue to offer these surgeries on pets when it is medically necessary.

Historically, tail docking and ear cropping were performed on purebred dogs so they complied with standards for that breed. The AKC continues to promote these procedures and explained to USA Today (they) “are acceptable practices integral to defining and preserving breed character, enhancing good health and preventing injuries.”

Tail docking is the surgical removal of part of the tail of a dog. It is performed on healthy puppies when they are between 2 – 5 days old. It is commonly performed on breeds such as Boxers, Schnauzers, Doberman pinschers and Rottweilers.

Ear cropping is a surgical procedure where a portion of the ear is removed. It is done to produce ears that stand erect. Ear cropping is performed on puppies around 8-12 weeks of age and is common on Great Danes, Boxers, Dobermans and more. The surgery is also used on Pit bulls to shorten the length of their ears and is most often seen in dogs used for fighting.

Devocalization or debarking is a cruel procedure that removes all or part of the vocal cords of a dog in order to prevent it from barking. The surgery is performed everywhere from puppy mills to dogs living in congested areas like apartment buildings.

The American Veterinary Medical Association (AVMA) is in agreement with Banfield and adopted a policy in 2008 stating that these procedures should only be done for therapeutic conditions. They also speculate that more purebred dog owners would comply with this policy if the AKC changed its standards and allowed these “unaltered” dogs to compete in dog shows.

[Many comments on this article defended the practices in terms very similar to the defence of circumcision.]

Prosecutors say parents argued before mutilation

A Houston couple argued over whether to have their 5-week-old infant
circumcised the day before his mother cut off the boy's penis and testicles,
leaving a perfectly square wound and a [future] childhood of reconstructive
surgeries, prosecutors told a jury Monday.

Oncken said Katherine Nadal, 28, argued for the circumcision after spending
the afternoon injecting cocaine. Camden Gothia, 38, testified that he argued
against it because of the pain it appears to cause.

[The question arises whether this would have happened if male circumcision were not customary - for example, if she would have done anything like this, even in her crazed state, if the baby had been a girl. ]

Earlier Monday, prosecutors told jurors that Nadal completely severed the
baby's genitals on March 13, 2007, then dispassionately watched neighbors,
paramedics and surgeons work to save the boy's life. None of the child's
parts was recovered.

Nadal is charged with injury to a child, causing serious bodily injury, a
first-degree felony. If convicted, she faces a maximum sentence of life in
prison. She remains in jail in lieu of $75,000 bail.

Defense claimsDefense attorneys Skip Cornelius and Allen Isbell said they will present
expert testimony that the wound could have been caused by a 7-pound
mini-dachshund, as Nadal told investigators.
...

Doctors want compulsory circumcision of soldiers

By Charles Ariko

HEALTH officials have recommended that uniformed personnel be circumcised as one of the means of preventing the spread of HIV/AIDS.

Dr. Stella Nema, a researcher on HIV/AIDS, yesterday said the Police, Prisons and army officers fall under the category that is now classified as the ‘most at risk’ population just like the commercial sex workers and long distance truck drivers.

Giving an example of the Uganda Prisons Service, Nema said when recruits join the service, their HIV/AIDS prevalence is at 1% but it shoots up to about 7% in less than five years after being passed out.

Nema was yesterday speaking at the launch of an HIV/AIDS counselling and testing campaign at Luzira Prison in Kampala.

[And are the prisoners being supplied with condoms?]

Dr. Zainabu Akol, the programme manager in charge of sexually transmitted diseases in the health ministry, said: “Male recruits who test HIV-negative should all get circumcised. Rwanda, Burundi and DR Congo are circumcising.”

Akol appealed to the recruits to test for HIV/AIDS so that they know their status, which she said would help them to remain healthy.

“When you know your status, you know where you belong. If you know that you are positive, protect yourself and others by having protected sex. If you are negative, remain negative,” Akol advised.

[If HIV+ men can protect themselves and others by having protected sex, why can't HIV- men?]

Dr. Johnson Byabashaija, the Commissioner General of Prisons, said knowing one’s status helps, especially those who might be HIV-positive and in need of treatment.

Son takes parents to court over circumcision

Biénne Huisman

Bhisho case could set important precedent for young men facing Xhosa initiation rite

Bonani Yamani is caught in a dilemma. He is crossing swords with his parents, who he respects and loves dearly, over a ritual intrinsic to their beliefs — but which clashes with his Christian convictions.

The 21-year-old has become embroiled in a clash between constitutional rights and Xhosa tradition — and is set to take on his parents’ beliefs on circumcision in court on Tuesday.

The second-year microbiology student at the University of the Free State will face his father, Lindile, and Eastern Cape traditional leaders in the Bhisho Equality Court in a legal fight that could give Xhosa boys a say in the way they are circumcised.

[How about a say in whether they are circumcised?]

Yamani claims that, shortly after he turned 18, his father and 10 other men abducted him from his home in Masele township near King William’s Town and subjected him to circumcision against his will — then forced him to eat the skin cut from his penis.

This, he said in a court affidavit, happened three months after he tried to compromise with local chiefs by having the procedure done at the Frere hospital in East London.

This week he told the Sunday Times : “After that experience I decided to do something about it so no other child is put through that.”

But while he wants justice, he does not want his parents to suffer.

“I don’t want my parents to be arrested and I don’t want them to pay money,” said Yamani, who is being helped by the Justice Alliance of South Africa, a non-profit legal organisation. “This is not revenge; I don’t want to get back at them. I just want my dad to admit that what he did was unconstitutional.

...

John Smyth, the director of Jasa, is pushing for forced circumcision to be declared illegal.

“Under the Children’s Act of 2005 it is illegal for any circumcision to be done on a boy over 16 without his written consent. Jasa wants a declaration making this clear, even when the circumcision is done as a traditional rite,” he said.

“We also want an order forbidding the chiefs from encouraging ostracism of a youth who refuses circumcision.”

The chairman of the Human Rights Commission, Jody Kollapen, said Yamani’s case should not be seen as an attack on Xhosa tradition and culture.

“It should be an examination of aspects thereof that may be harmful. From the commission’s point of view this is a very significant matter; in terms of ensuring that children’s voices are heard in matters affecting them,” said Kollapen.
...

Three accused of forcing boys into Islam

Shaikh Azizur Rahman, Foreign Correspondent

SHIVNAGRI, INDIA // Three people are expected to face trial for “forcibly converting” two boys to Islam following a mass circumcision.

Mangilal Kathat and his wife, Sakina Bano, whose two grandsons were among those involved, were arrested two days after the ceremony in Shivnagri village in Rajasthan, as was the man who performed the circumcisions.

The arrests in May came after Mr Kathat’s son, Rajesh, the father of the two boys, complained to police, saying the circumcisions had gone ahead without his approval.

The family is part of the Cheeta-Mehrat-Kathat clan who are descendants of Hindu rulers who converted to Islam 700 years ago. However, Rajesh Kathat, who works for the Indian navy and lives in Mumbai, and his wife, Yamuna, consider themselves Hindus and were upset at the circumcisions of their sons, Akash, 10 and Rahul, eight.

After spending three days in a police cell followed by 52 days in prison, the couple and Maolana Gheesu Khan, who performed the circumcisions, were released on bail last month. Police are expected to file charges in court this month.
...

Pastor forcefully circumcised

BY DEBORAH NYANGULU-CHIPOFYA

A 47-year-old pastor of Eleventh Hour Labour Ministry in Nkhotakota was on Saturday forcefully circumcised by a group of men who were conducting the ritual in the district.

Nkhotakota Police Spokesperson Labani Makalani said in an interview Tuesday the pastor, John Rashid Phiri, was in the morning hours of Saturday walking along the lakeshore looking for fish mongers when he accidentally bumped into a group of men who were circumcising young boys.

Makalani said the young men apprehended the pastor and took him to their leader where he was accused of trespassing into a sacred place.

“As punishment, the leader of the ritual ordered that the pastor should be circumcised. The pastor pleaded with the men not to circumcise him and even offered them money and his mobile phone, but they refused,” said Makalani.

The police spokesperson said after they circumcised the pastor, the men detained him for over nine hours and only released him later in the evening after he had paid a K400 fine.

After the release, the pastor lodged an official complaint with the police and was taken to the hospital where it was proved that his genitals were indeed mutilated.

Police have since arrested the circumcision leader, Musaiwa Moffat, 42, and Maulidi Chirwa, 42, and charged them with causing grievous harm.

It's time to dispense with the voodoo politics of the good condom and the guilty foreskin

By Kevin Myers

Voodoo is an African word, but not an African monopoly. Every society has its own voodoo -- a fear of some mysterious ailment which can only be cured by magical means.

The latest proposal by the World Health Organisation to control the AIDS epidemic in Africa by circumcising males is just another voodoo. However, the disproportionate number of women scientists urging this "solution" does suggest a bizarre twist -- some feminists, for obvious, if largely subconscious reasons, rather like the idea of male genital mutilation. Furthermore, the hygiene argument (usually used tendentiously) justifying male circumcision could equally apply to the female labia, and more especially, to the fingernails of both sexes.

About a year ago, I got into a spot of bother when I wrote that one of Africa's problems lay in its large numbers of priapic young male layabouts. It's an obvious truth, but ours is not a society which likes dealing with obvious truths, preferring to take comfort in the pious voodoo-fictions that Africa's problems are caused by European imperialism, apartheid and the lack of western aid.

If I were to repeat that column today, not many would care to differ, never mind call me a Nazi, as some brainless cretin in 'The Irish Daily Mail' did, nor seek to get me imprisoned, as did another equally brainless cretin from the National Migrant Council. For a recent survey of South African men has shown that 28pc of them had raped a woman or girl, and 3pc had raped a man or a boy. Almost half of these rapists had raped more than once, and nearly 75pc of them were under 20 at the time of their first rape. Moreover, the survey showed men who raped were also most likely to consort with prostitutes, and were less likely to use condoms.

Well, one reassuring aspect of all this is that rapists were twice as likely as non-rapists to die from AIDS. The downside is that so too were their victims, though in dear old South Africa, they are not always seen as victims. When the president, the gallant Jacob Zuma, was being tried for rape, his supporters gathered outside the courthouse, verbally abusing his HIV-infected accuser, singing, "Burn the bitch, burn the bitch". (How very charming. And how very less circumspectly the western media would have treated these stories if the leader accused of rape had been an Afrikaaner, and the ethnic group that had admitted to 28pc levels of rape, and had so colourfully abused the accuser, had been white).

I grow weary here, so let me conclude with this. A six-month-old baby who was gang raped in North Cape a couple of years ago (many African men believing that sex with a virgin can cure a man of AIDS) had subsequently to have a colostomy. The rapists walked free. And the trade union Solidarity reports that a child is raped every three minutes in South Africa. Now please, please, tell me what difference the presence or absence of a flap of skin on the penis can possibly make to the health of these African women and children?

Surveys in Uganda suggest that transmission rates of HIV/AIDS from women to circumcised men in consensual sex are 50pc those of uncircumcised. But a further -- and almost Mengelianly ghoulish experiment -- showed that circumcised men with HIV infected their partners at [at least] the same rate as did uncircumcised men [and perhaps as much as 1 ½ times the rate]. Well, what a surprise: and I trust the people who conducted these experiments, instead of telling the infected to refrain from penetrative sex completely, were satisfied with the outcome.

It's deeply unfashionable to say this, but the Pope was right when he insisted that condoms are not the answer to Africa's AIDS pandemic. For condoms have to be used every time -- and even then, they have a failure rate of 10pc.

[That's a misunderstanding of their failure rate in pregnanacy. "According to a 2000 report by the National Institutes of Health, correct and consistent use of latex condoms reduces the risk of HIV/AIDS transmission by approximately 85% relative to risk when unprotected, putting the seroconversion rate (infection rate) at 0.9 per 100 person-years with condom, down from 6.7 per 100 person-years." - Wikpedia]

This is a small problem when condoms are used as contraceptives, because the chances are that these accidents will happen when the woman is not fertile. But she is always vulnerable to HIV/AIDS. After having had safe condom-sex nine times, actuarially, what are her chances of completing an uninfected sexual act? How many days does it take healthy young people to have sex 10 times? [This assumes HIV is always transmitted when a condom is not used or fails.]

How are intact condoms to be distributed throughout the townships and the remote villages of sub-Saharan Africa? Finally, how many of the 28pc of South African hearties who rape will henceforth thoughtfully don a condom beforehand?

It's all voodoo: the voodoo of the good condom, and the voodoo of the guilty foreskin. And this latter is, paradoxically, a voodoo that is common to the most advanced societies in the world -- the US, Israel -- and the most backward, Somalia and Sudan.

It is one thing for an adult to choose to be circumcised, though little good will it do him if he chooses then to have unprotected promiscuous sex (as many newly-circumcised African males do). It is quite another thing for the World Health Organisation to encourage people to rob little boys of their foreskins for "public health" reasons.

To do that is to mutilate him forever, and all in the name of a very dangerous ancient/modern voodoo, that this year has killed 53 boys in Cape Province alone.

IOL NewsAugust 3, 2009

Two on the run after botched circumcision

Two men are on the run, after performing an illegal circumcision on a 16-year-old boy, resulting in his death, the Eastern Cape health department said on Monday.

"They performed a circumcision on the boy last week. The boy died at the illegal initiation school at the Chris Hani informal Settlement, west of Mthatha," health department spokesperson Sizwe Kupelo said.

He said when police and the department's task team visited the school on Sunday, the men, both in their early twenties, fled, along with three younger boys who had been circumcised.

...

Last week's death brings the illegal circumcision toll in the province since June to 53.

Male circumcision: Cutting into debate

By Fungai Machirori

I have always been skeptical about male circumcision (MC) as a preventative measure for HIV/AIDS, pondering just how effective it is for not only men, but also their female partners. A new study - carried out in Rakai district, Uganda - gives a glimpse into the answer. Sadly, it is not what activists in gender and HIV hoped to hear. It seems that male circumcision may actually increase women's transmission risk from their HIV positive circumcised male partner.

When in 2007, the World Health Organization (WHO) and UNAIDS recommended MC as an effective HIV prevention measure, I worried about all the praise that the practice was receiving for its efficacy. My fears centred around two points.

The first was that once a man had an MC operation done, he might begin to believe that all the risk of contracting HIV had lain within a flap of skin removed from his genitals. With that hotspot for HIV finally snipped off, he could think that he was now immune to the virus and engage in risky sexual activities - all to the detriment of himself, and his partners.

Secondly, I wondered what a 60% reduction in risk of heterosexually acquired HIV infection for men (as three MC trials in South Africa, Uganda and Kenya collectively approximated) really meant without a way to estimate similar harm reduction for women.

Many questions arose. What did MC really mean for male-to-female HIV transmission? Could it also protect women? Scientists and researchers also pondered these questions, which led to the recently released study in Uganda, involving 922 men living with HIV and 163 of their HIV-negative female.

The findings suggest that male circumcision may have actually increased HIV risk to some of the women in the intervention group. After six months, women whose partners ignored advice to abstain from sex for at least six weeks after the circumcision procedure had an HIV acquisition rate of 27.8%, compared to 9.5% among women whose male partners delayed sex until healing was complete, and 7.9% among women with uncircumcised partners.

[We are now down to very small whole numbers, making these figures seem spuriously accurate. Much also depends on the accuracy of self-reporting about sexual practices.]

Out of 92 couples in a group of circumcised men (used as the experiment group), 18% of the women became infected during the study period, compared to 12% of women in the uncircumcised control group. Alarm within circles that have embraced the call to scale up resources towards universal access to MC would be justified. After all, governments and organisations have already invested great quantities of human, technical and financial resources into the area.

[Yes, alarm would be justified, but so far no expression of alarm have come from the proponents of circumcision. Perhaps their personal involvement - and the great quantities of financial resources invested in them - is affecting their judgement?]

The health ministries of Botswana and Zambia have already put in place ambitious targets for national MC coverage, while several other sub-Saharan nations - where HIV still has its most fertile breeding ground - are in the process of conducting situational analyses and crafting policies around the practice.

However, before we kill MC off the HIV agenda, it is still worth looking into the factors that might have led to the negative results yielded by this most recent study. For a start, complacency kills.

Immediately after MC surgery, a couple may become more cautious about their sexual practices. Wounds from MC can take at least six weeks to heal, meaning no sexual activity for that whole period. However, initial diligence about hygiene and abstinence may not last this long.

Some men say they would never consider MC because they just would not be able to live without sex for six whole weeks. I wonder just how many of those who get circumcised might be re-engaging in sexual contact too soon after their operations - when open wounds around the penis give free access for the HI virus to pass on to a female partner during intercourse.

And yes, there can be complacency about condoms too. If you read the fine print closely enough, you will notice that MC always comes with a "disclaimer" - the practice should be carried out in tandem with continuing condom use for sex. MC is not a vaccine for HIV. It just reduces risks of transmission. Condoms, regular HIV testing and faithfulness are all still prerequisites in the effort to avoid infection and re-infection.

The second factor about MC relates to faithfulness. HIV negative men use MC to avoid initial infection, while men who are already HIV positive circumcise to avoid re-infection, as well as onward transmission of the virus. There is much to be lost for both groups if they begin believing that MC affords them some sort of exemption from HIV. Contrary to what many might think, MC is not a passport to risk-free sex.

These are the reasons for my skepticism about MC. Perhaps these new study findings are the jolt needed to realise that there is more work needed to correctly communicate the benefits and limitations of MC.

Certainly, it is an important component of a holistic approach to HIV reduction, but it must be linked to other critical services such as HIV counselling and testing, partner reduction and monogamy. On the other hand, when coupled with complacency and recklessness, MC becomes more of a bain than boon in our efforts towards eliminating HIV.

n Fungai Machirori is a writer from Zimbabwe. This article is part of the Gender Links Opinion and Commentary Service that provides fresh views on everyday news.

Circumcision deaths 'cause for concern'

The Eastern Cape health MEC was expected to meet traditional leaders on Tuesday to discuss the escalating number of deaths at initiation schools.

Phumulo Masualle would meet representatives from the House of Traditional Leaders as the provincial death toll from the winter circumcision season stood at 52, department spokesperson Sizwe Kupelo said.

...

"Some of these parents are frustrating our efforts because they insist the boys stay in the bush despite ill health," Kupelo said.

A total of 39 boys were admitted to the Mthatha General and the Nelson Mandela Academic in the last two weeks. They are still being treated there.

Nine others were currently receiving treatment at Frere Hospital, including one fighting for his life in the Intensive Care Unit.

Another boy was also in a critical condition at the Cecilia Makiwane Hospital in Mdantsane after being rescued from the mountains for a second time. He fell ill and was rescued. When he returned home his parents told him he needed to go back to the bush to complete the process.

Sudan's Female Genital Mutilation Countered By Henna-Dyed Hands

By H'Rina DeTroy

Sudan has tried to eradicate female genital mutilation since 1946 to little avail. But now women's health groups have taken the crusade in their hands--or rather, their own painted hands--in an effort to subvert the practice.

NGOs are training midwives and henna artists to cooperate using a secret code communicated through henna tattoos. Called the henna technique, a special design dyed temporarily on the skin can indicate to a midwife that a mother wants to avoid genital mutilation on her daughter. The tattoos serve as a bridge to discuss what is traditionally taboo. In turn, a midwife can stage a fake circumcision.

"It's underground," said Mawahib Mohamed of the Sudan Council of Volunteer Agencies (SCOVA). "It's totally something that women would invent." She said that midwives from the eastern and mountainous Nuer region invented the technique.

Mohamed said that SCOVA supports organizations dedicated to social and health-centered initiatives, like educating midwives about hygiene, immunizations and the risks of FGM. In Sudan, midwives help deliver babies and circumcise the girls after they reach the age of 5.

Normally, NGOs train midwives on how to counsel mothers about the dangers of FGM. Now they are taking bolder steps, showing midwives how to make a bogus ceremony, without any cutting.

But training midwives wasn't enough. Organizations also started teaching henna artists how to talk to clients about FGM. Unlike a midwife, who is present only during birth and circumcision, the interaction with a local henna artist is frequent because henna is applied on the hands and feet for occasions like engagements, baby showers and weddings. Married women always wear a basic design.

If a mother confides that she's afraid or worried about circumcising her daughter, a henna painter can refer the mother to a list of anti-FGM midwives. If the mother feels shy about broaching the subject, she can rely on a henna tattoo to communicate what she can't in words.

In traditional Sudanese communities, women who speak out against circumcision can be criticized for condoning promiscuity and infidelity.

"It's the only thing that works," said Mohamed, who was born in Sudan and lives in Brooklyn. She wore henna on the tips of her fingers, with a heart just below her thumb.

Midwives and henna artists who undermine it gain popularity through referrals to others in the same dilemma. In this way, eradication is clandestine and in women-only spaces.
...

Many Swedish doctors oppose circumcision

STOCKHOLM, Sweden, July 25 (UPI) -- Two out of three doctors surveyed in Sweden said they refuse to circumcise boys because they consider it assault without the child's consent, sources said.

The opposing doctors said they did not perform circumcisions unless the procedure was deemed medically necessary. Otherwise, they viewed the procedure as barbaric and akin to unnecessary female circumcision, said Gunnar Gothberg, chairman of the Swedish Pediatric Surgeons Association.

An estimated 3,000 male circumcisions are performed in Sweden each year, with about 2,000 of them performed by people who are not doctors and who do not have a medical license, The Local reported.

The Swedish Board of Health and Welfare has proposed regulating male circumcisions and requiring all municipalities to offer male circumcision for non-medical reasons.

Tears for Abonga - another dead initiate

WHEN school opened this term at Dlukulwana Junior Secondary School in the Transkei, the empty seat where 15-year-old Abonga Ndabetha used to sit brought tears to his classmates’ and teacher’s eyes.

Abonga, from KwaGebane village near Libode, died at St Barnabas Hospital on July 5.

He was one of 49 initiates who have died since the beginning of the season in the Eastern Cape, 43 of whom were from Transkei.

“The mood in my class is very low,” said his Grade 9 teacher, Funeka Zide , this week.

“I tried to speak to the pupils in order to console them, but I think psychologists need to intervene to counsel the pupils because they were close to Abonga.”

Zide described Abonga as handsome, neat and an average performer in his class work.

English and social science teacher Khaya Kupelo , who is also a sports trainer, said Abonga had been a promising cricket player.

...

Abonga had been sharing his desk with Oyama Mgogobala, 17, since January.

“We also did class work together and normally shared textbooks. He was a very quiet guy,” said Oyama.

Another classmate, Khanyisa Mdingi, 17, described Abonga as open-minded person who liked to make jokes.

“I’m hurt that he died,” said Khanyisa.

Five of his schoolmates who also underwent the rite at the same school are still in critical condition at St Barnabas Hospital near Libode .

They are among the 100 initiates, mostly pupils across the province, who are still in various hospitals.

Abonga’s death shocked his school community and the boy’s parents are angry that the illegal circumcisions continue in the village despite government’s stringent circumcision laws.

Thirty-two boys from Dlukulwana Junior Secondary School, aged between 13 and 17, had joined the local circumcision schools this winter without their parents’ consent and without going through compulsory pre-circumcision medical check- ups.

Dlukulwana Junior Secondary School’s Nomakhaya Ntuli, who has been the principal since 1996, said: ... “We try to talk to the boys about the importance of following the correct procedures of doing initiation, but it seems that they don’t listen, apparently as a result of peer pressure,” Ntuli said.

...

The survivors of the botched circumcisions admitted they did it without their parents’ permission .

...

The Daily Dispatch team visited Abonga’ s homestead and found his parents shocked and angry.

... Ndabetha said on June 26 he took his first-born (Abonga) to hospital after he had fallen ill and was bleeding.

“I wish the traditional circumcision (would) be banned among AmaMpondo because this is part of Xhosa and Sotho culture. This boy was the first in the long history of this family to undergo this practice,” Ndabetha said.

Antiretrovirals and condoms will have more effect on HIV in South Africa than circumcision, model finds

Gus Cairns & Michael Carter

In preliminary results from a mathematical model set up by researchers from the British Columbia Centre for Excellence in HIV/AIDS, male circumcision was found to have a considerably lower impact than condom use or antiretorviral therapy (ART) coverage on new HIV infection rates and on death rates in men in South Africa.

Researchers seeking to assess the population-level impact of different HIV prevention strategies in South Africa have developed a mathematical model that identifies increased condom use and ART coverage as keys to reducing new HIV infections in that country.

Presenter Viviane Lima told the conference that scaling condom use up from 14% (the current estimated level) to 50% and antiretroviral therapy coverage from 21% to 80% would result in an estimated 950,000 infections averted in men by 2019. Raising ART use to 50% and condom use to 80% would have a similar effect.

Raising both to 50% would result in 700,000 fewer infections. But raising circumcision rates from the current 51% of men circumcised to 90% would only add another 48,000 infections averted to this total.

Condom use and ART coverage, alone or in combination, were found to reduce new HIV infections by from 64% to 95% by 2025 and to reduce mortality by 10% to 34%. Circumcision brought about a 3% to 13% reduction in new HIV infections and a 2% to 4% reduction in mortality; according to Lima, its impact “was overshadowed when combined with the other interventions.

Closet Case: How Intolerance Fuels Africa's AIDS Crisis

By Megan Lindow

New research has challenged the long-standing belief that HIV and AIDS in Africa primarily affect heterosexuals. A study published on the website of the British medical journal Lancet found that men who have sex with other men are up to 10 times more likely than their heterosexual counterparts to be infected with the virus — which suggests that the fight against AIDS on the continent may be undermined by widespread homophobia.

Researchers from Oxford University, the Population Council of Ghana and the Kenya Medical Research Institute reviewed AIDS studies conducted over the past few years and concluded that male-male sex was a major blind spot in AIDS research and policy in Africa. Men having sex with other men is far more common in Africa than is socially acknowledged, owing to widespread hostility toward homosexuality, and the phenomenon there is underreported in research and largely ignored in public-health responses to the pandemic. ...

Male-male sex is a criminal offense in some 31 sub-Saharan African countries; it even draws the death penalty in a few — on the books, at least, if hardly ever in practice.

...

"In countries that protect sexual minorities, those groups are able to access services and reduce their risks," the lead researcher, Adrian Smith, tells TIME. "But as long as behaviors remain criminalized and stigmatized, you're on the one hand asking a group to identify themselves and be integrated into a health system — but then the state still poses structural obstacles to prevent them doing that."

In Uganda, whose government is considering a law to criminalize the distribution of literature with homosexual content, gays are often the targets of fire-and-brimstone sermons and public rallies. Ugandan activists say that if the law is passed, it would prevent them from educating people about safe sexual behaviors — another issue highlighted in the report.

The report found that gay men are more likely than heterosexuals to engage in risky behaviors, perhaps because AIDS-prevention messages are aimed at heterosexuals. "There are many men in Africa who think that anal sex is safe, because they have never been told that it's not," says Smith.

HIV: Male circumcision does not shield [may increase risk to] women

Male circumcision unleashed a wave of optimism among AIDS campaigners three years ago when trials in Kenya, Uganda and South Africa found foreskin removal more than halved men’s risk of infection by the human immunodeficiency virus (HIV).

Last year, longer-term analysis of one of the trials found the benefit to be even greater than thought, with a risk reduction of 65 percent.

One of the big questions, though, is whether male circumcision could also reduce the risk for women who have intercourse with an HIV-infected man.

The answer, according to a randomised trial carried out in Uganda, is a clear “No.”

Doctors enrolled 922 uncircumcised Ugandan men aged 15-49 who were badly infected with HIV but who did not show any symptoms.

Half of the group then had circumcision, while the other half remained uncircumcised.

The researchers also enrolled HIV-uninfected women who were partners of the male volunteers. These numbered 90 women in the circumcised group, and 70 in the uncircumcised groups.

All participants were intensively schooled in HIV prevention.

The trial was halted at a partway stage because it would have been futile and questionable to carry on.

Analysis of data after two years made it clear that there was no protection: 18 percent of women in the circumcised group who were examined at the follow-up point had become infected, as opposed to 12 percent in the control group.

[That's 17 partners of circumcised men and 8 partners of intact men - probably not enough to be statistically significant - which raises the question of how many would have had to be infected to show that circumcision conferred any protection? ]

Most of the infections in the circumcised group occurred within six months after circumcision.

This may have been because some of the men had intercourse without giving time for the circumcision wound to heal properly, thus exposing the woman to HIV-infected blood in the vagina. [...or because the keratinised glans, and the rougher action of newly circumcised men struggling to gain the same stimulation with ~20,000 fewer nerve-endings, creates microtears in the vagina facilitating the entry of HIV from the semen - but they don't want to think of that, because it throws their favourite operation into doubt. Note that early infection forcloses the way to later infection, so more infections will inevitably be earlier rather than later, just as most products are sold soon after a sale begins.]

That finding was surprising and provides a lesson for programmes to promote male circumcision as a cheap, effective method of preventing HIV among men, say the authors.

[Yes and the lesson is, "Stop wasting your time and putting lives at risk."]

Men who undergo circumcision must be closely counselled about strictly observing sexual abstinence until the wound heals, and about also using condoms to stop infecting their partner. [And if they do that, what difference can circumcision make?]

The doctors, led by Maria Wawer of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, say they were disappointed with the outcome.

Even if women do not directly benefit from male circumcision, they get an indirect advantage, because the fewer men who are infected with HIV [by having unprotected sex with other women], the lesser the risk to women. [If, on the other hand, circumcising men increases the risk to women, as this study suggests, they get a direct disadvantage. And one cynic has added, there will be fewer men infected with HIV because they will all be dead.]

A study published in October last year in the Journal of the American Medical Association (JAMA) found that the protective benefit of circumcision to male heterosexuals does not appear to extend to male homosexuals.

>Among 53,567 men who reported having male sexual partners, researchers found little difference in the rate of HIV infection between those who were circumcised and those were not.

The theory behind the effectiveness of circumcision is that the inner foreskin is an easy entry point for HIV. It is rich in so-called Langerhans cells, tissue that the AIDS virus finds particularly easy to latch on to and penetrate.

Other questions surrounding circumcision campaigns are the need to ensure that operations are done hygienically and with the full knowledge and consent of the male[...which would rule out infant and child circumcision.].

Zim boys forcibly circumcised in SA

FIVE Zimbabwean boys were last week kidnapped and forcibly circumcised after they allegedly went near a circumcision school while loading sand into a truck in Manamani Village of Thohoyandou in South Africa.

The alleged circumcision has forced Zimbabwean authorities to call on people staying in South Africa to exercise caution and seek assistance from authorities when they need help.

Speaking from Johannesburg, an official at the Zimbabwe consul said his office was concerned with the number of children travelling to South Africa without parental guidance.

"There are children who are skipping the border in search of work and they end up being caught up in such situations.

"While there is not much we can do to assist these boys who have either fled their homes or have lost their parents and moved down south, we would like to urge Zimbabweans to be extra- cautious when they come to South Africa.

"It’s risky to move into a foreign country and children should be accompanied by their parents or guardians lest they get lost," the official said.

According to a South African newspaper, The Citizen, a local businessman identified as Hendrick Mulangaphuma, who had hired the boys to load sand into a truck witnessed the incident.

The paper quoted Mulangaphuma as saying: "The men appeared from nowhere. The elder of the group instructed the others to grab the five Zimbabweans to be circumcised in the bush school.

"That was done while the other group grabbed my wife."

His wife is reported to have escaped, leaving him and their 14-year-old son in the truck.

The man said the group blamed him for coming too close to the school with a woman and uncircumcised Zimbabweans. They were all forced to prove whether or not they had been circumcised.

Mulangaphuma said he was taken to Chief Musanda Ravele from the village where he was ordered to pay R250 for each Zimbabwean and R500 each for their food in the bush.

Community must act on circumcisions - police

Circumcision deaths in the Eastern Cape rose from 41 to 43 over the weekend while eight boys are in a critical condition in hospital, the province's health department said on Tuesday.

Spokesperson Sizwe Kupelo said the eight boys receiving specialised treatment in hospital were among 39 who were rescued in the Ngqeleni and Gumbu areas on Monday.

The department appealed for community members to help put an end to the winter circumcision deaths - the bulk of them of initiates attending illegal schools.

"Our efforts are being frustrated by people hiding the boys away and as a result, they continue to die," said Kupelo. 'That is the only way we can put a stop to this' He explained that community members, who knew the perpetrators, did not report the crimes.

"They decide among themselves not to report the matter to authorities because they know the perpetrator will be arrested.

"They wait until the eleventh hour and by that stage, it is too late and the victims are certified dead at hospital."

Kupelo urged residents to help the department and police capture the perpetrators.

"We are asking these community members to apprehend the culprits and call the police, and we will come and arrest them.

'The law is clear'"That is the only way we can put a stop to this," he said.

So far, 11 people have been arrested in connection with illegal circumcisions crime, and the cases were pending.

Kupelo cautioned parents to be aware of the law.

"The law is clear. If you want to circumcise your boy, take him to a doctor for a medical examination.

"The doctors will then be able to tell you if your boy is fit to do so. If he has tuberculosis, or pneumonia, or a sexually transmitted infection, then he is not fit."

He said another problem interfering with the department's campaign to end circumcision deaths, was that boys were being taken to the highest peaks of mountains or deep within dense forests to undergo circumcisions.

This was making it hard for authorities to rescue them.

Kupelo said the circumcision death rate would have "more than doubled" had it not been for the health department and police launching rescue operations.

He said so far, more than 200 boys had been rescued from the former Transkei district through the campaign.

The department said it would intensify its campaign on Tuesday by deploying officials to the affected areas to conduct their duties.

The province's circumcision legislation required schools and the traditional surgeons and nurses that run them, to be registered.

AVMA delegates reaffirm opposition to cosmetic ear cropping

Seattle - While several AVMA delegates expressed displeasure about being cut out of last November's ear cropping and tail docking policy change, the buzzwords on Friday were that any policy reversal would result in negative "unintended consequences."

As a result, the American Veterinary Medical Association's (AVMA) House of Delegates shot down proposed changes to the policy advocating a softer position about performing these cosmetic procedures.

The resolution would have acknowledged the practice of ear cropping and tail docking and inserted language like: "It is imperative that the procedures be performed by trained, licensed and caring veterinarians using current standards of care."

The failed resolution was introduced by the Utah Veterinary Medical Association, and spurred a great deal of debate.

Arguments acknowledged these cosmetic procedures are accepted cultural practices and similar to ear piercing and circumcision (without a child's consent). Others said the United States is behind other developed countries by not banning these cosmetic procedures.
...

Promotion of Male Circumcision at IAS 2009 Conference Is a Mistake

AIDS Policy Makers Wearing Blinders to the Costs and Harms of Male
Circumcision

The human rights group NOCIRC of South Africa (NOCIRC-SA), represented at
the IAS 2009 conference this week, is urging AIDS policy makers to halt
male circumcision rollout, calling the plan exorbitant, dangerous and
unethical.

´The promotion of male circumcision sends the wrong message, creates a
false sense of protection, and places women at greater risk for HIV. Men
are already lining up to be circumcised in the belief that they no longer
need condoms. Women and children may be the most harmed by the promotion
of male circumcision," said Shelton Kaye, Co-Director of NOCIRC-SA.

New studies released since three highly-publicised randomized controlled
trials (RCTs) on HIV and circumcision show that RCT results cannot be
applied to the general population of sub-Saharan Africa or any other
region. A 2008 study concluded that male circumcision is not associated
with reduced HIV infection rates in the general sub-Saharan population.
Another recent study analysed circumcision rates and HIV incidence in
South Africa, finding that: "Circumcision had no protective effect on HIV
transmission."

"The RCTs conclusions are questionable. The only supported conclusion that can be drawn from the RCTs is that circumcision might delay HIV infection.

"Even if the RCTs´ claims were valid," Kaye said, "a 2008 study found that
increased use of condom promotion would be 95 times more cost-effective
than male circumcision in preventing new HIV infections."

"Especially troubling is the extraordinarily high rate of complications
from male circumcision in Africa," Kaye added. "A 2008 WHO bulletin
reported an alarming 35% complication rate for traditional circumcisions
and an 18% complication rate for clinical circumcisions, Africa´s
overburdened health care system cannot handle the tens of thousands of
circumcision complications that would result from mass circumcision
campaigns." Studies have shown removal of the foreskin results in a less
sensitive penis. A less sensitive penis, coupled with the reduced
sensitivity afforded by condoms, encourages males to forgo condoms.

"It is unethical for circumcisions to be carried out on adult males unless fully informed consent has been obtained," Kaye said. "The number of
reports of African males agreeing to circumcision, so that they no longer
need to use condoms, reveals they are consenting to the surgery without
fully informed consent."

Of particular ethical concern is the recent increase in advocacy for
neonatal circumcision to prevent HIV. Neonatal circumcision destroys
erogenous tissue and places newborns at immediate risk of infection,
haemorrhage, penile damage, and in rare cases, even death. "When one
considers the goal to potentially reduce, if at all, risk of acquiring
AIDS 15-20 years later," Kaye said, "neonatal circumcision looks
especially farfetched in comparison to other preventive measures."

Kaye concludes: "The promotion of male circumcision for HIV prevention is
fraught with very serious logistical, monetary and ethical concerns.
Proponents of circumcision have yet to suggest a long-term monitoring
system to evaluate failure or success of the exaggerated claims based on
three RCTs which contradict real-world population samples. While the world is desperate for a "silver bullet" to end the HIV epidemic, it should be
obvious that male circumcision is not the answer that we have been waiting for."

Mass circumcision in Kayunga

KAYUNGA on Thursday became the first district to launch mass male circumcision aimed at reducing the spread of HIV. Doctors said the exercise would expand to the rest of the country.

Dr Ahmad Matovu, the Kayunga Hospital superintendent, said they had circumcised 320 men since February. “We circumcise an average of 15 males every Thursday,” Matovu said. “The youngest so far was a 13-year-old boy, but the average age is 19 years. The older people are not so receptive.”

To facilitate the drive, the theatre at Kayunga Hospital was renovated with support from the Makerere University Walter Reed Project and the US government. The medical staff also received training.

Research carried out in Rakai and other parts of Africa established that circumcised men are less prone to HIV. Prof. Wabwire Mangeni, who participated in the research, said circumcision would be used in conjunction with advocating abstinence, being faithful and using condoms to fight AIDS.

Dr. Zainab Akol, the head of the National AIDS Control Programme, said the Government was formulating a policy for medical male circumcision. One of the proposals is to introduce mandatory circumcision of boys within 24 hours after birth. She said circumcision is also good for maintaining hygiene in the male genitalia. The health ministry says about 25% of Ugandan men are circumcised.

Support for female circumcision declining in Egypt

The current government in Egypt banned female circumcision in the 1990s and strengthened the restriction in 2007 after a high-profile case where a 12-year-old girl died after the ritual.

However, female circumcision is still widespread, says Ann Way, a researcher with the organization Measure DHS, which has been collecting information on the practice since 1995.

Measure DHS helps countries calculate vital statistics by doing large surveys, often repeated over the course of years. Way and her colleagues asked women about female circumcision again in 2000, and most recently, last year. She says they are starting to see a reduction in the number of young women who have been circumcised.

The government ban, along with the well-publicized deaths, led some people - most importantly women and religious leaders - to start questioning the practice.

Interestingly, fewer wealthy girls and women currently have the practice performed on them. Only about a third of girls in the wealthiest 20 percent of Egypt’s population will be circumcised by the time they’re 18. In contrast, in the poorest 20 percent, about three-quarters of the girls will end up circumcised.

Way says attitudes and practices change slowly. She says even if fewer girls are circumcised, it will take time for the total number of adult women who have been circumcised to drop.

E Cape circumcision toll tops 40

The death toll in the Eastern Cape's winter circumcision season has
reached 41, the provincial health department said on Thursday.

Spokesperson Sizwe Kupelo said the most recent deaths were on Wednesday
night, of two boys at initiation schools in the Mthatha area.

Autopsies were being done on all the youths to establish causes of
death.

He said 53 youths rescued from illegal schools were currently being
treated at hospitals in Mthatha, 26 at St Barnabas Hospital in Libode,
27 at Canzibe in Ngqeleni and 34 at St Elizabeth in Lusikisiki.

Kupelo said the department was advertising 33 new posts on its
circumcision team as a matter of urgency. - Sapa

[When will they admit that more circumcision is not the solution, it's the problem?]

Botched circumcisions kill 33 boys in South Africa

Thirty-three South African boys have died following botched circumcisions in the country’s Eastern Cape province, radio reports said Sunday. [Whether they were "botched" is questionable. It is unknown whether the circumcisions of those who died were performed any differently from those who didn't.]

For many boys in South Africa, circumcision marks the transition to manhood.

The group procedure is usually carried out in winter. Each year brings its share of fatalities, which are usually blamed on the use of blunt, unsterilised instruments.
...

The commonest causes of death are septicaemia from infected wounds, and dehydration, which happens when initiates are denied water by their handlers.

Many more youths are hospitalised each year with infected or mutilated penises.

Eastern Cape is not the only area affected. In May, the northeastern Mpumalanga province also reported several circumcision deaths.

In 2001, the government passed an act requiring practitioners to have a license from a medical officer for each circumcision, but traditional leaders resisted the measure, saying it infringed communities’ rights.

Botched circumcisions leave 31 dead in S.Africa

JOHANNESBURG (AFP) — Thirty-one teenage boys have died from complications after botched traditional circumcision rites in South Africa's rural Eastern Cape region, officials said on Friday.

"Since the beginning of June, two deaths are being recorded almost every day," regional health spokesman Sizwe Kupelo told AFP.

"This is a grim situation that we deal with every year, the health department has rescued hundreds of boys from schools run by unscrupulous surgeons," he said.

Health authorities say the main causes of death which have been concentrated in the rural Transkei area are dehydration, hypothermia and excessive bleeding and that most boys only seek medical attention when it is too late.

Traditional circumcision is a rite of passage practised by the region's Xhosa clan, where boys from the age of 18 are banished to the bush for about a month and taught social values.

The bi-annual event culminates in a circumcision ritual which is performed without any anaesthetic, using traditional surgical tools.
...

Museveni condemns genital cutting

A law against female circumcision will soon be enacted, President Yoweri Museveni has said.

Launching a campaign against female genital mutilation in Nakapiripirit in Karamoja, Museveni described the practice among the Sabiny and Pokot communities as brutal and backward.

“God knew what he was doing when he created us. Do you think you are more intelligent than God?” he asked, drawing laughter from the crowd attending the occasion.

“Are you the ones who made the woman the way she is? Can you even make an inch of that part you cut? If God did his engineering, who are you to destroy it?”

He explained that every part of the human body has its function. “There is no part of a human being that is useless. When I injured my figure [finger?] while doing exercises, I spent weeks without doing my work normally. Now you, people, interfere with God’s work.”

He dismissed the argument that female circumcision is part of the culture of the Karimojong.

“I support culture. That is why I restored the kingdoms. But you must support culture that is useful and based on scientific information.”

He called the practice dangerous, not only to women but also to new-born babies who risk dying because of prolonged labour, caused by the destruction of the elastic mechanism.

Some women have become paralysed while others have died due to female circumcision, he noted.

“I use spectacles for cutting my nails. But these old women who have no spectacles cut even other parts, causing harm to the victims.”

Pointing at a 44-year-old crippled woman, who was circumcised in 1976 in Kapchorwa, he said: “See that lady on the wheelchair, she is a victim of the bad practice.”

The President pledged to support an alternative source of income for women who earn a living by circumcising girls. He told the cheering crowd that he skipped the AU summit in Sirte, Libya, to launch the campaign.

Accompanied by his wife, Janet, who is also the state minister for Karamoja affairs, Museveni launched the drive at Amudat Senior Secondary School on Wednesday.
...

A 15-year-old boy died in the Nelson Mandela Academic hospital in Mthatha today (July 1) after developing complications from an illegal circumcision, Eastern Cape police said.

Superintendent Mzukisi Fatyela said the boy died in the early hours of the morning after being rushed to hospital last night.

The circumcision, also involving six other boys, happened in the Kaplan locality near Mthatha.

Some of the other boys were also taken to hospital but were in a stable condition.

The man who had performed the circumcision had fled after the first boy was rushed to hospital.

A case of illegal circumcision was opened and the man was being sought by police.

The Circumcision Act stated that a boy under 16 years was not ready for circumcision and that the procedure could only be carried out by trained and authorised people.

On Monday a 15-year-old boy from Ngqeleni near Mthatha died after a similarly botched circumcision.

The boy was rushed to hospital along with seven others on Monday evening where he later died.

The 31-year-old traditional surgeon who allegedly performed the circumcision was on the run and police were looking for him to face a charge of contravening the Circumcision Act, Fatyela said on Tuesday.